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Almalki YE, Basha MAA, Metwally MI, Zeed NA, Nada MG, Alduraibi SK, Morsy AA, Balata R, Al Attar AZ, Amer MM, Farag MAEAM, Aly SA, Basha AMA, Hamed EM. Validating Brain Tumor Reporting and Data System (BT-RADS) as a Diagnostic Tool for Glioma Follow-Up after Surgery. Biomedicines 2024; 12:887. [PMID: 38672241 PMCID: PMC11048183 DOI: 10.3390/biomedicines12040887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/03/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Gliomas are a type of brain tumor that requires accurate monitoring for progression following surgery. The Brain Tumor Reporting and Data System (BT-RADS) has emerged as a potential tool for improving diagnostic accuracy and reducing the need for repeated operations. This prospective multicenter study aimed to evaluate the diagnostic accuracy and reliability of BT-RADS in predicting tumor progression (TP) in postoperative glioma patients and evaluate its acceptance in clinical practice. The study enrolled patients with a history of partial or complete resection of high-grade glioma. All patients underwent two consecutive follow-up brain MRI examinations. Five neuroradiologists independently evaluated the MRI examinations using the BT-RADS. The diagnostic accuracy of the BT-RADS for predicting TP was calculated using histopathology after reoperation and clinical and imaging follow-up as reference standards. Reliability based on inter-reader agreement (IRA) was assessed using kappa statistics. Reader acceptance was evaluated using a short survey. The final analysis included 73 patients (male, 67.1%; female, 32.9%; mean age, 43.2 ± 12.9 years; age range, 31-67 years); 47.9% showed TP, and 52.1% showed no TP. According to readers, TP was observed in 25-41.7% of BT-3a, 61.5-88.9% of BT-3b, 75-90.9% of BT-3c, and 91.7-100% of BT-RADS-4. Considering >BT-RADS-3a as a cutoff value for TP, the sensitivity, specificity, and accuracy of the BT-RADS were 68.6-85.7%, 84.2-92.1%, and 78.1-86.3%, respectively, according to the reader. The overall IRA was good (κ = 0.75) for the final BT-RADS classification and very good for detecting new lesions (κ = 0.89). The readers completely agreed with the statement "the application of the BT-RADS should be encouraged" (score = 25). The BT-RADS has good diagnostic accuracy and reliability for predicting TP in postoperative glioma patients. However, BT-RADS 3 needs further improvements to increase its diagnostic accuracy.
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Affiliation(s)
- Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran 61441, Saudi Arabia;
| | - Mohammad Abd Alkhalik Basha
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt; (M.I.M.); (N.A.Z.); (M.G.N.); (E.M.H.)
| | - Maha Ibrahim Metwally
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt; (M.I.M.); (N.A.Z.); (M.G.N.); (E.M.H.)
| | - Nesma Adel Zeed
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt; (M.I.M.); (N.A.Z.); (M.G.N.); (E.M.H.)
| | - Mohamad Gamal Nada
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt; (M.I.M.); (N.A.Z.); (M.G.N.); (E.M.H.)
| | | | - Ahmed A. Morsy
- Department of Neurosurgery, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt;
| | - Rawda Balata
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt; (R.B.); (A.Z.A.A.)
| | - Ahmed Z. Al Attar
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt; (R.B.); (A.Z.A.A.)
| | - Mona M. Amer
- Department of Neurology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt;
| | | | - Sameh Abdelaziz Aly
- Department of Diagnostic Radiology, Faculty of Human Medicine, Benha University, Benha 13511, Egypt;
| | | | - Enas Mahmoud Hamed
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt; (M.I.M.); (N.A.Z.); (M.G.N.); (E.M.H.)
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El-Azony A, Basha MAA, Almalki YE, Abdelmaksoud B, Hefzi N, Alnagar AA, Mahdey S, Ali IM, Nasr I, Abdalla AAEHM, Yousef HY, Zaitoun MMA, Elsayed SB, Nada MG, Amin MI, Hassan RM, Ali SA, Dawoud TM, Aly SA, Algazzar YH, Abdelhamed H. The prognostic value of bone marrow retention index and bone marrow-to-liver ratio of baseline 18F-FDG PET/CT in diffuse large B-cell lymphoma. Eur Radiol 2024; 34:2500-2511. [PMID: 37812294 DOI: 10.1007/s00330-023-10150-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To determine prognostic value of bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) measured on baseline dual-phase 18F-FDG PET/CT in a series of newly diagnosed patients with diffuse large B-cell lymphoma (DLBCL) treated homogeneously with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy. PATIENTS AND METHODS This prospective study enrolled 135 patients with newly diagnosed DLBCL. All patients underwent dual-phase 18F-FDG PET/CT. The following PET parameters were calculated for both tumor and bone marrow: maximum standardized uptake value (SUVmax) at both time points (SUVmax early and SUVmax delayed), SUVmax increment (SUVinc), RI, and BLR. Patients were treated with R-CHOP regimen and response at end of treatment was assessed. RESULTS The final analysis included 98 patients with complete remission. At a median follow-up of 22 months, 57 patients showed no relapse, 74 survived, and 24 died. The 2-year relapse-free survival (RFS) values for patients with higher and lower RI-bm were 20% and 65.1%, respectively (p < 0.001), and for patients with higher and lower BLR were 30.2% and 69.6%, respectively (p < 0.001). The 2-year overall survival (OS) values for patients with higher and lower RI-bm were 60% and 76.3%, respectively (p = 0.023), and for patients with higher and lower BLR were 57.3% and 78.6%, respectively (p = 0.035). Univariate analysis revealed that RI-bm and BLR were independent significant prognostic factors for both RFS and OS (hazard ratio [HR] = 4.02, p < 0.001, and HR = 3.23, p < 0.001, respectively) and (HR = 2.83, p = 0.030 and HR = 2.38, p = 0.041, respectively). CONCLUSION Baseline RI-bm and BLR were strong independent prognostic factors in DLBCL patients. CLINICAL RELEVANCE STATEMENT Bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) could represent suitable and noninvasive positron emission tomography/computed tomography (PET/CT) parameters for predicting pretreatment risk in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy. KEY POINTS • Bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) are powerful prognostic variables in diffuse large B-cell lymphoma (DLBCL) patients. • High BLR and RI-bm are significantly associated with poor overall survival (OS) and relapse-free survival (RFS). • RI-bm and BLR represent suitable and noninvasive risk indicators in DLBCL patients.
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Affiliation(s)
- Ahmed El-Azony
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad Abd Alkhalik Basha
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt.
| | - Yassir Edrees Almalki
- Division of Radiology, Department of Medicine, Medical College, Najran University, Najran, Kingdom of Saudi Arabia
| | - Bader Abdelmaksoud
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nabila Hefzi
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed A Alnagar
- Department of Medical Oncology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Sheren Mahdey
- Department of Nuclear Medicine, Nasser Institute, Health Ministry, Cairo, Egypt
| | - Ismail Mohamed Ali
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ibrahim Nasr
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed A El-Hamid M Abdalla
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Hala Y Yousef
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed M A Zaitoun
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Saeed Bakry Elsayed
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamad Gamal Nada
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed I Amin
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Rania Mostafa Hassan
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Susan Adil Ali
- Department of Diagnostic Radiology, Intervention and Molecular Imaging, Faculty of Human Medicine, Ain Shams University, Cairo, Egypt
| | - Tamer Mahmoud Dawoud
- Department of Diagnostic Radiology, Faculty of Human Medicine, Tanta University, Tanta, Egypt
| | - Sameh Abdelaziz Aly
- Department of Diagnostic Radiology, Faculty of Human Medicine, Benha University, Benha, Egypt
| | | | - Heba Abdelhamed
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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Hassan RM, Almalki YE, Basha MAA, Gobran MA, Alqahtani SM, Assiri AM, Alqahtani S, Alduraibi SK, Aboualkheir M, Almushayti ZA, Aldhilan AS, Aly SA, Alshamy AA. Magnetic Resonance Imaging Features of Rhino-Orbito-Cerebral Mucormycosis in Post-COVID-19 Patients: Radio-Pathological Correlation. Diagnostics (Basel) 2023; 13:diagnostics13091546. [PMID: 37174937 PMCID: PMC10177362 DOI: 10.3390/diagnostics13091546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
There has been a notable increase in rhino-orbito-cerebral mucormycosis (ROCM) post-coronavirus disease 2019 (COVID-19), which is an invasive fungal infection with a fatal outcome. Magnetic resonance imaging (MRI) is a valuable tool for early diagnosis of ROCM and assists in the proper management of these cases. This study aimed to describe the characteristic MRI findings of ROCM in post-COVID-19 patients to help in the early diagnosis and management of these patients. This retrospective descriptive study was conducted at a single hospital and included 52 patients with COVID-19 and a histopathologically proven ROCM infection who were referred for an MRI of the paranasal sinuses (PNS) due to sino-orbital manifestations. Two radiologists reviewed all the MR images in consensus. The diagnosis was confirmed by histopathological examination. The maxillary sinus was the most commonly affected PNS (96.2%). In most patients (57.7%), multiple sinuses were involved with the black turbinate sign on postcontrast images. Extrasinus was evident in 43 patients with orbital involvement. The pterygopalatine fossa was involved in four patients. Three patients had cavernous sinus extension, two had pachymeningeal enhancement, and one had epidural collection. The alveolar margin was affected in two patients, and five patients had an extension to the cheek. The awareness of radiologists by the characteristic MRI features of ROCM in post-COVID-19 patients helps in early detection, early proper management, and prevention of morbid complications.
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Affiliation(s)
- Rania Mostafa Hassan
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran 61441, Saudi Arabia
| | | | - Mai Ahmed Gobran
- Department of Surgical Pathology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Saad Misfer Alqahtani
- Department of Pathology, College of Medicine, Najran University Hospital, Najran University, Najran 61441, Saudi Arabia
| | - Abdullah M Assiri
- Department of Surgery, College of Medicine, Najran University, Najran 61441, Saudi Arabia
| | - Saeed Alqahtani
- Department of Surgery, College of Medicine, Najran University, Najran 61441, Saudi Arabia
| | | | - Mervat Aboualkheir
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia
| | - Ziyad A Almushayti
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia
| | - Asim S Aldhilan
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia
| | - Sameh Abdelaziz Aly
- Department of Diagnostic Radiology, Faculty of Human Medicine, Benha University, Benha 13511, Egypt
| | - Asmaa A Alshamy
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
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Hassan RM, Almalki YE, Basha MAA, Alduraibi SK, Aboualkheir M, Almushayti ZA, Aldhilan AS, Aly SA, Alshamy AA. The Impact of Adding Digital Breast Tomosynthesis to BI-RADS Categorization of Mammographically Equivocal Breast Lesions. Diagnostics (Basel) 2023; 13:diagnostics13081423. [PMID: 37189524 DOI: 10.3390/diagnostics13081423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
Digital mammography (DM) is the cornerstone of breast cancer detection. Digital breast tomosynthesis (DBT) is an advanced imaging technique used for diagnosing and screening breast lesions, particularly in dense breasts. This study aimed to evaluate the impact of combining DBT with DM on the BI-RADS categorization of equivocal breast lesions. We prospectively evaluated 148 females with equivocal BI-RADS breast lesions (BI-RADS 0, 3, and 4) with DM. All patients underwent DBT. Two experienced radiologists analyzed the lesions. They then assigned a BI-RADS category for each lesion according to the BI-RADS 2013 lexicon, using DM, DBT, and integrated DM and DBT. We compared the results based on major radiological characteristics, BI-RADS classification, and diagnostic accuracy, using the histopathological examination of the lesions as a reference standard. The total number of lesions was 178 on DBT and 159 on DM. Nineteen lesions were discovered using DBT and were missed by DM. The final diagnoses of 178 lesions were malignant (41.6%) and benign (58.4%). Compared to DM, DBT produced 34.8% downgrading and 32% upgrading of breast lesions. Compared with DM, DBT decreased the number of BI-RADS 4 and 3. All the upgraded BI-RADS 4 lesions were confirmed to be malignant. The combination of DM and DBT improves the diagnostic accuracy of BI-RADS for evaluating and characterizing mammographic equivocal breast lesions and allows for proper BI-RADS categorization.
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Affiliation(s)
- Rania Mostafa Hassan
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran 61441, Saudi Arabia
| | | | | | - Mervat Aboualkheir
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia
| | - Ziyad A Almushayti
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia
| | - Asim S Aldhilan
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia
| | - Sameh Abdelaziz Aly
- Department of Diagnostic Radiology, Faculty of Human Medicine, Benha University, Benha 13511, Egypt
| | - Asmaa A Alshamy
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
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Mazroua JA, Almalki YE, Alaa M, Alduraibi SK, Aboualkheir M, Aldhilan AS, Almushayti ZA, Aly SA, Basha MAA. Precision Mapping of Intrahepatic Biliary Anatomy and Its Anatomical Variants Having a Normal Liver Using 2D and 3D MRCP. Diagnostics (Basel) 2023; 13:diagnostics13040726. [PMID: 36832212 PMCID: PMC9955884 DOI: 10.3390/diagnostics13040726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/05/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
Despite significant advances in hepatobiliary surgery, biliary injury and leakage remain typical postoperative complications. Thus, a precise depiction of the intrahepatic biliary anatomy and anatomical variant is crucial in preoperative evaluation. This study aimed to evaluate the precision of 2D and 3D magnetic resonance cholangiopancreatography (MRCP) in exact mapping of intrahepatic biliary anatomy and its variants anatomically in subjects with normal liver using intraoperative cholangiography (IOC) as a reference standard. Thirty-five subjects with normal liver activity were imaged via IOC and 3D MRCP. The findings were compared and statistically analyzed. Type I was observed in 23 subjects using IOC and 22 using MRCP. Type II was evident in 4 subjects via IOC and 6 via MRCP. Type III was observed equally by both modalities (4 subjects). Both modalities observed type IV in 3 subjects. The unclassified type was observed in a single subject via IOC and was missed in 3D MRCP. Accurate detection by MRCP of intrahepatic biliary anatomy and its anatomical variants was made in 33 subjects out of 35, with an accuracy of 94.3% and a sensitivity of 100%. In the remaining two subjects, MRCP results provided a false-positive pattern of trifurcation. MRCP competently maps the standard biliary anatomy.
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Affiliation(s)
- Jehan A. Mazroua
- Department of Diagnostic Radiology, Faculty of Human Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran 61441, Saudi Arabia
- Correspondence:
| | - Mohamed Alaa
- Department of Diagnostic Radiology, Faculty of Human Medicine, Mansoura University, Mansoura 35516, Egypt
| | | | - Mervat Aboualkheir
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia
| | - Asim S. Aldhilan
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia
| | - Ziyad A. Almushayti
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia
| | - Sameh Abdelaziz Aly
- Department of Diagnostic Radiology, Faculty of Human Medicine, Benha University, Benha 13511, Egypt
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Almalki YE, Basha MAA, Refaat R, Alduraibi SK, Abdalla AAEHM, Yousef HY, Zaitoun MMA, Elsayed SB, Mahmoud NEM, Alayouty NA, Ali SA, Alnaggar AA, Saber S, El-Maghraby AM, Elsheikh AM, Radwan MHSS, Abdelmegid AGI, Aly SA, Shanab WSA, Obaya AA, Abdelhai SF, Elshorbagy S, Haggag YM, Mokhtar HM, Sabry NM, Altohamy JI, Abouelkheir RT, Omran T, Shalan A, Algazzar YH, Metwally MI. Bosniak classification version 2019: a prospective comparison of CT and MRI. Eur Radiol 2023; 33:1286-1296. [PMID: 35962816 DOI: 10.1007/s00330-022-09044-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/13/2022] [Accepted: 07/19/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the diagnostic accuracy and agreement of CT and MRI in terms of the Bosniak classification version 2019 (BCv2019). MATERIALS AND METHODS A prospective multi-institutional study enrolled 63 patients with 67 complicated cystic renal masses (CRMs) discovered during ultrasound examination. All patients underwent CT and MRI scans and histopathology. Three radiologists independently assessed CRMs using BCv2019 and assigned Bosniak class to each CRM using CT and MRI. The final analysis included 60 histopathologically confirmed CRMs (41 were malignant and 19 were benign). RESULTS Discordance between CT and MRI findings was noticed in 50% (30/60) CRMs when data were analyzed in terms of the Bosniak classes. Of these, 16 (53.3%) were malignant. Based on consensus reviewing, there was no difference in the sensitivity, specificity, and accuracy of the BCv2019 with MRI and BCv2019 with CT (87.8%; 95% CI = 73.8-95.9% versus 75.6%; 95% CI = 59.7-87.6%; p = 0.09, 84.2%; 95% CI = 60.4-96.6% versus 78.9%; 95% CI = 54.4-93.9%; p = 0.5, and 86.7%; 95% CI = 64.0-86.6% versus 76.7%; 95% CI = 75.4-94.1%; p = 0.1, respectively). The number and thickness of septa and the presence of enhanced nodules accounted for the majority of variations in Bosniak classes between CT and MRI. The inter-reader agreement (IRA) was substantial for determining the Bosniak class in CT and MRI (k = 0.66; 95% CI = 0.54-0.76, k = 0.62; 95% CI = 0.50-0.73, respectively). The inter-modality agreement of the BCv219 between CT and MRI was moderate (κ = 0.58). CONCLUSION In terms of BCv2019, CT and MRI are comparable in the classification of CRMs with no significant difference in diagnostic accuracy and reliability. KEY POINTS • There is no significant difference in the sensitivity, specificity, and accuracy of the BCv2019 with MRI and BCv2019 with CT. • The number of septa and their thickness and the presence of enhanced nodules accounted for the majority of variations in Bosniak classes between CT and MRI. • The inter-reader agreement was substantial for determining the Bosniak class in CT and MRI and the inter-modality agreement of the BCv219 between CT and MRI was moderate.
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Affiliation(s)
- Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran, Kingdom of Saudi Arabia
| | | | - Rania Refaat
- Department of Diagnostic Radiology, Intervention and Molecular Imaging, Faculty of Human Medicine, Ain Shams University, Cairo, Egypt
| | - Sharifa Khalid Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia
| | | | - Hala Y Yousef
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed M A Zaitoun
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Saeed Bakry Elsayed
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nader E M Mahmoud
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nader Ali Alayouty
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Susan Adil Ali
- Department of Diagnostic Radiology, Intervention and Molecular Imaging, Faculty of Human Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmad Abdullah Alnaggar
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Sameh Saber
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Amgad M Elsheikh
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | | | - Sameh Abdelaziz Aly
- Department of Diagnostic Radiology, Faculty of Human Medicine, Benha University, Benha, Egypt
| | - Waleed S Abo Shanab
- Department of Diagnostic Radiology, Faculty of Human Medicine, Port Said University, Port Said, Egypt
| | - Ahmed Ali Obaya
- Department of Clinical Oncology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Shaimaa Farouk Abdelhai
- Department of Clinical Oncology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Shereen Elshorbagy
- Department of Medical Oncology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Yasser M Haggag
- Department of Urology, Faculty of Human Medicine, Al Azhar University, Cairo, Egypt
| | - Hwaida M Mokhtar
- Department of Diagnostic Radiology, Faculty of Human Medicine, Tanta University, Tanta, Egypt
| | - Nesreen M Sabry
- Department of Clinical Oncology, Faculty of Human Medicine, Tanta University, Tanta, Egypt
| | - Jehan Ibrahim Altohamy
- Department of Diagnostic Radiology, National Institute of Urology and Nephrology, Cairo, Egypt
| | - Rasha Taha Abouelkheir
- Department of Diagnostic Radiology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Tawfik Omran
- Department of Diagnostic Radiology, Faculty of Human Medicine, Helwan University, Cairo, Egypt
| | - Ahmed Shalan
- Department of Diagnostic Radiology, Faculty of Human Medicine, Benha University, Benha, Egypt
| | | | - Maha Ibrahim Metwally
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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7
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Basha MAA, Shemais DS, Abdelwahed ES, Elfwakhry RM, Zeid AF, Abdalla AAEHM, Aly SA, Abdelrahman DS, Elshenawy AA, Mansour W, Elbanna KAA, El Tahlawi M, Elnahal N. Computed Tomography Imaging Assessment of the Effect of Vancomycin Paste on Poststernotomy Healing. Int J Gen Med 2021; 14:9287-9296. [PMID: 34880667 PMCID: PMC8648099 DOI: 10.2147/ijgm.s343124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess vancomycin paste effect on poststernotomy healing in high-risk coronary artery bypass grafting (CABG) patients compared to bone wax using the 6-point computed tomography (CT) score. Additionally assessed the reliability of this score and its relationship to the occurrence of infection. Patients and Methods A prospective comparative analysis included 126 high-risk CABG patients. The patients were randomly assigned into bone wax or vancomycin paste for sternal haemostasis. All patients were submitted to CT examinations 6-months postoperative. Two radiologists independently reviewed all CT scans to assess sternal healing using the 6-point CT score. The CT healing score of the two groups was compared. The kappa statistics were used to calculate the inter-reader agreement (IRA) of the 6-point CT score. Results The final analysis included 61 patients in each group. The main CT score for sternal healing was 3.9±0.4 in the vancomycin group and 3.3±0.8 in the bone wax group. Patients in the vancomycin group had a higher statistically significant improvement in CT healing score than those in the bone wax group (p<0.001). There was no statistically significant relationship (p = 0.79) between the occurrence of infection and the 6-point CT score in the vancomycin group. The overall IRA of the 6-point CT score was good in two groups (κ = 0.79 in the vancomycin group and = 0.78 in the bone wax group). Conclusion Vancomycin paste had a better CT healing score and can be used as a sternal haemostatic material instead of bone wax. The 6-point CT healing score is a reliable diagnostic tool for evaluating sternal healing.
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Affiliation(s)
| | - Dina Said Shemais
- Department of Cardiothoracic Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Essam Saad Abdelwahed
- Department of Cardiothoracic Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Ayman Fathy Zeid
- Department of Radiodiagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Sameh Abdelaziz Aly
- Department of Radiodiagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt
| | | | - Anwar A Elshenawy
- Department of Surgical Oncology, Faculty of Human Medicine, Aswan University, Aswan, Egypt
| | - Waleed Mansour
- Department of Chest Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Mohammad El Tahlawi
- Department of Cardiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nezar Elnahal
- Department of Cardiothoracic Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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Abdel-Tawab M, Basha MAA, Mohamed IAI, Ibrahim HM, Zaitoun MMA, Elsayed SB, Mahmoud NEM, El Sammak AA, Yousef HY, Aly SA, Khater HM, Mosallam W, Abo Shanab WS, Hendi AM, Hassan S. Comparison of the CO-RADS and the RSNA chest CT classification system concerning sensitivity and reliability for the diagnosis of COVID-19 pneumonia. Insights Imaging 2021; 12:55. [PMID: 33913066 PMCID: PMC8081002 DOI: 10.1186/s13244-021-00998-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/09/2021] [Indexed: 12/21/2022] Open
Abstract
Background The Radiological Society of North America (RSNA) recently published a chest CT classification system and Dutch Association for Radiology has announced Coronavirus disease 2019 (COVID-19) reporting and data system (CO-RADS) to provide guidelines to radiologists who interpret chest CT images of patients with suspected COVID-19 pneumonia. This study aimed to compare CO-RADS and RSNA classification with respect to their sensitivity and reliability for diagnosis of COVID-19 pneumonia. Results A retrospective study assessed consecutive CT chest imaging of 359 COVID-19-positive patients. Three experienced radiologists who were aware of the final diagnosis of all patients, independently categorized each patient according to CO-RADS and RSNA classification. RT-PCR test performed within one week of chest CT scan was used as a reference standard for calculating sensitivity of each system. Kappa statistics and intraclass correlation coefficient were used to assess reliability of each system. The study group included 359 patients (180 men, 179 women; mean age, 45 ± 16.9 years). Considering combination of CO-RADS 3, 4 and 5 and combination of typical and indeterminate RSNA categories as positive predictors for COVID-19 diagnosis, the overall sensitivity was the same for both classification systems (72.7%). Applying both systems in moderate and severe/critically ill patients resulted in a significant increase in sensitivity (94.7% and 97.8%, respectively). The overall inter-reviewer agreement was excellent for CO-RADS (κ = 0.801), and good for RSNA classification (κ = 0.781). Conclusion CO-RADS and RSNA chest CT classification systems are comparable in diagnosis of COVID-19 pneumonia with similar sensitivity and reliability.
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Affiliation(s)
- Mohamed Abdel-Tawab
- Department of Diagnostic Radiology, Faculty of Human Medicine, Assiut University, Assiut, Egypt
| | | | - Ibrahim A I Mohamed
- Department of Diagnostic Radiology, Faculty of Human Medicine, Assiut University, Assiut, Egypt
| | - Hamdy M Ibrahim
- Department of Diagnostic Radiology, Faculty of Human Medicine, Assiut University, Assiut, Egypt
| | - Mohamed M A Zaitoun
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Saeed Bakry Elsayed
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nader E M Mahmoud
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed A El Sammak
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Hala Y Yousef
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Sameh Abdelaziz Aly
- Department of Radio-diagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt
| | - Hamada M Khater
- Department of Radio-diagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt
| | - Walid Mosallam
- Department of Radio-diagnosis, Faculty of Human Medicine, Suiz Canal University, Esmaelia, Egypt
| | - Waleed S Abo Shanab
- Department of Radio-diagnosis, Faculty of Human Medicine, Port Said University, Port Said, Egypt
| | - Ali M Hendi
- Department of Radiology, College of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Sayed Hassan
- Department of Diagnostic Radiology, Faculty of Human Medicine, Assiut University, Assiut, Egypt
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9
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Almassry HN, Basha MAA, Zaitoun MMA, Abdelazim M, Harb OA, Aly SA. The validity of grayscale and color Doppler ultrasound in assessment of scrotal swellings: a retrospective study in a large case series. Acta Radiol 2021; 62:266-275. [PMID: 32336118 DOI: 10.1177/0284185120916836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Scrotal swellings have a non-specific clinical picture, so their clinical diagnosis is challenging. Scrotal grayscale and color Doppler ultrasound are non-invasive methods used in both adult and childhood groups and act as accurate screening and diagnostic modalities. PURPOSE To evaluate the diagnostic validity of grayscale and color Doppler ultrasound in the assessment of scrotal swelling to reach accurate diagnosis. MATERIAL AND METHODS A retrospective study included 181 patients (mean age = 35.5 ± 7.3, age range = 1-71 years) with scrotal swelling. Examinations were performed by an experienced radiologist using grayscale and color Doppler ultrasound. The diagnostic validity of grayscale and color Doppler ultrasound for diagnosing scrotal swelling were estimated using surgical findings, histopathological results, and imaging and clinical follow-up as reference standards. RESULTS Overall, 202 scrotal swellings were detected. The final diagnoses were 13 (6.4%) malignant and 189 (93.6%) benign alterations. Varicocele was the most common scrotal swelling (26%), followed by hydrocele (23.8%). Matched to the reference standards, grayscale and color Doppler ultrasound represented a sensitivity of 84.6% (95% confidence interval [CI] = 54.6-98.1), a specificity of 76.2% (95% CI = 69.5-82.1), a positive predictive value of 19.6% (95% CI = 10.2-32.4), and a negative predictive value of 98.6% (95% CI = 95.1-99.8) for diagnosing scrotal tumors. CONCLUSION Scrotal grayscale and color Doppler ultrasound provide high diagnostic validity for assessment of scrotal swellings.
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Affiliation(s)
- Hosam Nabil Almassry
- Department of Radiodiagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Mohamed MA Zaitoun
- Department of Radiodiagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Abdelazim
- Department of Urology, Faculty of Human Medicine, Benha University, Benha, Egypt
| | - Ola A Harb
- Department of Pathology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Sameh Abdelaziz Aly
- Department of Radio-diagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt
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10
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Basha MAA, Eldib DB, Aly SA, Azmy TM, Mahmoud NEM, Ghandour TM, Aly T, Mostafa S, Elaidy AM, Algazzar HY. Diagnostic accuracy of ultrasonography in the assessment of anterior knee pain. Insights Imaging 2020; 11:107. [DOI: https:/doi.org/10.1186/s13244-020-00914-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/16/2020] [Indexed: 09/02/2023] Open
Abstract
Abstract
Background
Anterior knee pain (AKP) is a problematic complaint, considered to be the most frequent cause of orthopedic consultancy for knee problems. This study aimed to highlight diagnostic accuracy of ultrasonography as a fast imaging technique in assessment of patients with AKP.
Methods and results
A prospective study was conducted on 143 patients with clinically confirmed AKP. All patients underwent ultrasonography and MRI examinations of the knee. The diagnostic accuracy of ultrasonography compared to MRI for evaluating different findings of possible causes of AKP were analyzed using receiver operating characteristic (ROC) curve and judged by area under curve (AUC). A total of 155 knees were included in the study; 26 knees showed no abnormalities, 19 knees showed positive MRI only, and 110 knees showed positive ultrasonography and MRI. Ultrasonography and MRI reported 11 different findings of possible causes of AKP or related to it. Joint effusion was the most common finding (38%) followed by trochlear cartilage defect (20.6%) and superficial infrapatellar subcutaneous edema (20%). The overall accuracy of ultrasonography was 85.3% sensitivity and 100% specificity. The ultrasonography provided the highest sensitivity (100%) in detecting bipartite patella, followed by 91.5% for joint effusion, and 87.5% for quadriceps tendinopathy. The ROC curve analysis of overall accuracy of ultrasonography showed an AUC of 0.93. The overall Kappa agreement between ultrasonography and MRI was good (k = 0.66).
Conclusion
Ultrasonography can be used to make a swift screening and assessment of painful anterior knee and as an alternative to MRI when it is unavailable or contraindicated.
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11
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Basha MAA, Eldib DB, Aly SA, Azmy TM, Mahmoud NEM, Ghandour TM, Aly T, Mostafa S, Elaidy AM, Algazzar HY. Diagnostic accuracy of ultrasonography in the assessment of anterior knee pain. Insights Imaging 2020; 11:107. [PMID: 33000350 PMCID: PMC7527384 DOI: 10.1186/s13244-020-00914-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022] Open
Abstract
Background Anterior knee pain (AKP) is a problematic complaint, considered to be the most frequent cause of orthopedic consultancy for knee problems. This study aimed to highlight diagnostic accuracy of ultrasonography as a fast imaging technique in assessment of patients with AKP. Methods and results A prospective study was conducted on 143 patients with clinically confirmed AKP. All patients underwent ultrasonography and MRI examinations of the knee. The diagnostic accuracy of ultrasonography compared to MRI for evaluating different findings of possible causes of AKP were analyzed using receiver operating characteristic (ROC) curve and judged by area under curve (AUC). A total of 155 knees were included in the study; 26 knees showed no abnormalities, 19 knees showed positive MRI only, and 110 knees showed positive ultrasonography and MRI. Ultrasonography and MRI reported 11 different findings of possible causes of AKP or related to it. Joint effusion was the most common finding (38%) followed by trochlear cartilage defect (20.6%) and superficial infrapatellar subcutaneous edema (20%). The overall accuracy of ultrasonography was 85.3% sensitivity and 100% specificity. The ultrasonography provided the highest sensitivity (100%) in detecting bipartite patella, followed by 91.5% for joint effusion, and 87.5% for quadriceps tendinopathy. The ROC curve analysis of overall accuracy of ultrasonography showed an AUC of 0.93. The overall Kappa agreement between ultrasonography and MRI was good (k = 0.66). Conclusion Ultrasonography can be used to make a swift screening and assessment of painful anterior knee and as an alternative to MRI when it is unavailable or contraindicated.
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Affiliation(s)
| | - Diaa Bakry Eldib
- Department of Radiodiagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt
| | - Sameh Abdelaziz Aly
- Department of Radiodiagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt
| | - Taghreed M Azmy
- Department of Radiodiagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nader E M Mahmoud
- Department of Radiodiagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Tarek Mohamed Ghandour
- Department of Orthopaedic Surgery, Faculty of Human Medicine, Ain Shams University, Cairo, Egypt
| | - Tarek Aly
- Department of Orthopaedic Surgery, Faculty of Human Medicine, Tanta University, Tanta, Egypt
| | - Shimaa Mostafa
- Department of Rheumatology and Rehabilitation, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Asmaa M Elaidy
- Department of Psychiatry, Faculty of Human Medicine for Girls, Al-Azhar University, Zagazig, Egypt
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12
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Basha MAA, Metwally MI, Gamil SA, Khater HM, Aly SA, El Sammak AA, Zaitoun MMA, Khattab EM, Azmy TM, Alayouty NA, Mohey N, Almassry HN, Yousef HY, Ibrahim SA, Mohamed EA, Mohamed AEM, Afifi AHM, Harb OA, Algazzar HY. Comparison of O-RADS, GI-RADS, and IOTA simple rules regarding malignancy rate, validity, and reliability for diagnosis of adnexal masses. Eur Radiol 2020; 31:674-684. [PMID: 32809166 DOI: 10.1007/s00330-020-07143-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/27/2020] [Accepted: 08/03/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The American College of Radiology (ACR) recently published the ovarian-adnexal reporting and data system (O-RADS) to provide guidelines to physicians who interpret ultrasound (US) examinations of adnexal masses (AM). This study aimed to compare the O-RADS with two other well-established US classification systems for diagnosis of AM. METHODS This retrospective multicenter study between May 2016 and December 2019 assessed consecutive women with AM detected by the US. Five experienced consultant radiologists independently categorized each AM according to O-RADS, gynecologic imaging reporting and data system (GI-RADS), and international ovarian tumor analysis (IOTA) simple rules. Pathology and adequate follow-up were used as reference standards for calculating the validity of three US classification systems for diagnosis of AM. Kappa statistics were used to assess the inter-reviewer agreement (IRA). RESULTS A total of 609 women (mean age, 48 ± 13.7 years; range, 18-72 years) with 647 AM were included. Of the 647 AM, 178 were malignant and 469 were benign. Malignancy rates were comparable to recommended rates by previous literature in O-RADS and IOTA, but higher in GI-RADS. O-RADS had significantly higher sensitivity for malignancy than GI-RAD and IOTA (p = 0.003 and 0.0007, respectively), but non-significant slightly lower specificity (p > 0.05). O-RADS, GI-RADS, and IOTA showed similar overall IRA (κ = 0.77, 0.69, and 0.63, respectively) with a tendency toward higher IRA with O-RADS than with GI-RADS and IOTA. CONCLUSIONS O-RADS compares favorably with GI-RADS and IOTA. O-RADS had higher sensitivity than GI-RADS and IOTA simple rules with relatively similar specificity and reliability. KEY POINTS • The malignancy rates were comparable to recommended rates by previous literature in O-RADS and IOTA, but higher in GI-RADS. • The O-RADS had significantly higher sensitivity for malignancy than GI-RADS and IOTA (96.8% vs 92.7% and 92.1%; p = 0.003 and 0.0007, respectively), but non-significant slightly lower specificity (92.8% vs 93.6% and 93.2%, respectively; p > 0.05). • The O-RADS, GI-RADS, and IOTA showed similar overall inter-reviewer agreement (IRA) (κ = 0.77, 0.69, and 0.63, respectively), with a tendency toward higher IRA with O-RADS than with GI-RADS and IOTA.
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Affiliation(s)
| | | | - Shrif A Gamil
- Department of Radio-diagnosis, Al-Ahrar Teaching Hospital, Zagazig, Egypt
| | - Hamada M Khater
- Department of Radio-diagnosis, Benha University, Benha, Egypt
| | | | | | | | - Enass M Khattab
- Department of Radio-diagnosis, Zagazig University, Zagazig, Egypt
| | - Taghreed M Azmy
- Department of Radio-diagnosis, Zagazig University, Zagazig, Egypt
| | | | - Nesreen Mohey
- Department of Radio-diagnosis, Zagazig University, Zagazig, Egypt
| | | | - Hala Y Yousef
- Department of Radio-diagnosis, Zagazig University, Zagazig, Egypt
| | - Safaa A Ibrahim
- Department of Obstetrics & Gynecology, Zagazig University, Zagazig, Egypt
| | - Ekramy A Mohamed
- Department of Obstetrics & Gynecology, Zagazig University, Zagazig, Egypt
| | | | | | - Ola A Harb
- Department of Pathology, Zagazig University, Zagazig, Egypt
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Basha MAA, Abdelrahman HM, Metwally MI, Alayouty NA, Mohey N, Zaitoun MMA, Almassry HN, Yousef HY, El Sammak AA, Aly SA, Algazzar HY, Farag MAEAM, Mosallam W, Abo Shanab WS, Ibrahim SA, Mohamed EA, Mohamed AEM, Afifi AHM, Harb OA, Azmy TM. Validity and Reproducibility of the ADNEX MR Scoring System in the Diagnosis of Sonographically Indeterminate Adnexal Masses. J Magn Reson Imaging 2020; 53:292-304. [PMID: 32715577 DOI: 10.1002/jmri.27285] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The diagnosis of sonographically indeterminate adnexal masses (AM) signifies a major challenge in clinical practice. Early detection and characterization have increased the need for accurate imaging evaluation before treatment. PURPOSE To assess the validity and reproducibility of the ADNEX MR Scoring system in the diagnosis of sonographically indeterminate AM. STUDY TYPE A prospective multicenter study. POPULATION In all, 531 women (mean age, 44 ± 11.2 years; range, 21-79 years) with 572 sonographically indeterminate AM. FIELD STRENGTH/SEQUENCE 1.5T/precontrast T1 -weighted imaging (WI) fast spin echo (FSE) (in-phase and out-of-phase, with and without fat suppression); T2 -WI FSE; diffusion-WI single-shot echo planner with b-values of 0 and 1000 s/mm2 ; and dynamic contrast-enhanced perfusion T1 -WI liver acquisition with volume acceleration (LAVA). ASSESSMENT All MRI examinations were evaluated by three radiologists, and the AM were categorized into five scores based on the ADNEX MR Scoring system. Score 1: no AM; 2: benign AM; 3: probably benign AM; 4: indeterminate AM; 5: probably malignant AM. Histopathology and imaging follow-up were used as the standard references for evaluating the validity of the ADNEX MR Scoring system for detecting ovarian malignancy. STATISTICAL TESTS Four-fold table test, kappa statistics (κ), and receiver operating characteristic (ROC) curve. RESULTS In all, 136 (23.8%) AM were malignant, and 436 (76.2%) were benign. Of the 350 AM classified as score 2, one (0.3%) was malignant; of the 62 AM classified as score 3, six (9.7%) were malignant; of the 73 AM classified as score 4, 43 (58.9%) were malignant; and of the 87 AM categorized as score 5, 86 (98.9%) were malignant. The best cutoff value for predicting malignant AM was score >3 with sensitivity and specificity of 92.9% and 94.9%, respectively. The interreader agreement of the ADNEX MR Scoring was very good (κ = 0.861). DATA CONCLUSION The current study supports the high validity and reproducibility of the ADNEX MR Scoring system for the diagnosis of sonographically indeterminate AM. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
| | - Hossam M Abdelrahman
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Maha Ibrahime Metwally
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nader Ali Alayouty
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nesreen Mohey
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed M A Zaitoun
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Hosam Nabil Almassry
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Hala Y Yousef
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed A El Sammak
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Sameh Abdelaziz Aly
- Department of Radio-Diagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt
| | | | | | - Walid Mosallam
- Department of Radio-Diagnosis, Faculty of Human Medicine, Suez Canal University, Ismailia, Egypt
| | - Waleed S Abo Shanab
- Department of Radio-Diagnosis, Faculty of Human Medicine, Port Said University, Port Said, Egypt
| | - Safaa A Ibrahim
- Department of Obstetrics & Gynecology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ekramy A Mohamed
- Department of Obstetrics & Gynecology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Abd El Motaleb Mohamed
- Department of Clinical Oncology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Ola A Harb
- Department of Pathology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Taghreed M Azmy
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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Basha MAA, Saber S, El-Hamid M Abdalla AA, Aly SA, GObran T, Waly A, Arafa AS. Assessment of the testicular vascularity after inguinal herniotomy in children: a prospective color Doppler study. Acta Radiol 2020; 61:128-135. [PMID: 31091967 DOI: 10.1177/0284185119851236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Knowing transient vascular perfusion abnormalities of testes after open inguinal herniotomy procedure is essential for the surgeon who is mainly responsible for the patient outcome. Purpose To assess the effect of open inguinal herniotomy procedure on the testicular blood supply in children using duplex ultrasonography (DUS). Material and Methods A prospective observational study included 60 boys (mean age = 9.46 ± 14.46 months; age range = 2 months–6 years) who underwent open inguinal herniotomy operation. Using DUS, the testicular volume, peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were calculated preoperatively and one week, one month, and six months postoperatively. The pre- and postoperative measurements were compared. Statistical analysis was performed using χ2 test, Fisher’s exact test, or Student’s t-test when appropriate. Results On physical examination, the hernias were unilateral in 57 boys and bilateral in three boys. Comparison between testicular volumes preoperatively and postoperatively showed no significant change ( P > 0.05). There was a statistically significant increase of PSV and RI one week and one month postoperatively ( P < 0.0001) but returned to be near to the preoperative values at six months. As regards EDV, there was a slight but non-significant postoperative increase ( P > 0.05) which did not return to the preoperative value. Conclusion The affection of testicular vascularity postoperatively is transient and returns to be near to the preoperative values in the late postoperative period (six months postoperatively). Additionally, no significant change in testicular volume postoperatively.
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Affiliation(s)
| | - Sameh Saber
- Department of Radiodiagnosis, Zagazig University, Zagazig, Egypt
| | | | | | - T GObran
- Department of Pediatric Surgery, Zagazig University, Zagazig, Egypt
| | - Amira Waly
- Department of Pediatric Surgery, Zagazig University, Zagazig, Egypt
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15
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Basha MAA, Aly SA, Ismail AAA, Bahaaeldin HA, Shehata SM. The validity and applicability of CAD-RADS in the management of patients with coronary artery disease. Insights Imaging 2019; 10:117. [PMID: 31802266 PMCID: PMC6893004 DOI: 10.1186/s13244-019-0806-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronary artery disease reporting and data system (CAD-RADS) is designed for a uniform standardization of coronary computed tomography angiography (CCTA) reporting and further management recommendations of coronary artery disease (CAD). This study aimed to assess clinical validity, applicability, and reproducibility of CAD-RADS in the management of patients with CAD. METHODS AND RESULTS A single-center prospective study included 287 patients with clinically suspected or operated CAD who underwent CCTA. Four reviewers evaluated the CCTA images independently and assigned a CAD-RADS category to each patient. The invasive coronary angiography (ICA) was used as the reference standard for calculating diagnostic performance of CAD-RADS for categorizing the degree of coronary artery stenosis. The intra-class correlation (ICC) was used to test the inter-reviewer agreement (IRA). Reporting was provided to referring consultants according to the CAD-RADS. Based on ICA results, we have 156 patients with non-significant CAD and 131 patients with significant CAD. On a patient-based analysis, regarding those patients classified as CAD-RADS 4 and CAD-RADS 5 for predicting significant CAD, the CAD-RADS had a sensitivity, specificity, and an accuracy of 100%, 96.8 to 98.7%, and 98.3 to 99.3%, respectively, depending on the reviewer. There was an excellent IRA for CAD-RADS categories (ICC = 0.9862). The best cutoff value for predicting significant CAD was > CAD-RADS 3. Eighty-seven percentage of referring consultants considered CAD-RADS reporting system to be "quite helpful" or "completely helpful" for clinical decision-making in CAD. CONCLUSION CAD-RADS is valuable for improving CCTA structural reports and facilitating decision-making with high diagnostic accuracy and high reproducibility.
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Affiliation(s)
| | | | - Ahmad Abdel Azim Ismail
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Hanan A Bahaaeldin
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Samar Mohamad Shehata
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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El-Haieg DO, Madkour NM, Basha MAA, Ahmad RA, Sadek SM, Al-Molla RM, Tantwy EF, Almassry HN, Altaher KM, Mahmoud NEM, Aly SA. Magnetic resonance imaging and 3-dimensional transperineal ultrasound evaluation of pelvic floor dysfunction in symptomatic women: a prospective comparative study. Ultrasonography 2019; 38:355-364. [PMID: 31466142 PMCID: PMC6769195 DOI: 10.14366/usg.19007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/06/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose The purpose of this study was to investigate magnetic resonance imaging (MRI) and 3-dimensional transperineal ultrasound (3D-TPUS) features of pelvic floor dysfunction (PFD) in symptomatic women in correlation with digital palpation and to define cut-offs for hiatal dimensions predictive of muscle dysfunction. Methods This prospective study included 73 women with symptoms suggesting PFD. 3D-TPUS, MRI, and digital palpation of the levator ani muscle were performed in all patients. Levator hiatal antero-posterior (LHap) diameter and area (LH area) were measured at rest and at maximum muscle contraction. Results The reduction in LHap diameter and LH area during contraction was significantly less in women with underactive pelvic floor muscle contraction (UpfmC) than in those who had normal pelvic floor muscle contraction by digital palpation (P<0.001). Statistically significant positive correlations (P<0.001) were found between the Modified Oxford Score and 3D-TPUS and MRI regarding the reduction in the LHap diameter (r=0.80 and r=0.82, respectively) and LH area (r=0.60 and r=0.70, respectively). A reduction in LHap of <6.5% on 3D-TPUS and <7.6% on MRI predicted UpfmC with sensitivities of 46.2% and 82.7%, respectively. A reduction in LH area of <3.4% on 3D-TPUS and <3.8% on MRI predicted UpfmC with sensitivities of 75.0% and 88.5%, respectively. MRI was more sensitive in detecting levator avulsion (63.4%) than 3D-TPUS (27.1%). Conclusion MRI and 3D-TPUS had strong positive correlations with findings on palpation, and at certain cut-offs for hiatal dimensions, they can be used as complementary and objective tools to improve the accuracy of diagnosis and management planning of PFD.
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Affiliation(s)
- Dahlia O El-Haieg
- Department of Obstetrics and Gynecology, Zagazig University, Zagazig, Egypt
| | - Nadia M Madkour
- Department of Obstetrics and Gynecology, Zagazig University, Zagazig, Egypt
| | | | - Reda A Ahmad
- Department of Obstetrics and Gynecology, Zagazig University, Zagazig, Egypt
| | - Somayya M Sadek
- Department of Obstetrics and Gynecology, Zagazig University, Zagazig, Egypt
| | - Rania M Al-Molla
- Department of Radiodiagnosis, Zagazig University, Zagazig, Egypt
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Alkhalik Basha MA, Refaat R, Ahmed AF, Yousef HY, Alsowey AM, Metwally MI, Aly SA, Hussien HM, El-Saadany HF, AlGhobashy AA, Talat MA, Amer MM, Eid AM. Brain magnetic resonance spectroscopy (MRS) as a diagnostic tool for detecting early neurological changes in children with Wilson's disease. Eur J Radiol 2018; 111:41-46. [PMID: 30691663 DOI: 10.1016/j.ejrad.2018.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/06/2018] [Accepted: 12/13/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Although brain magnetic resonance spectroscopy (MRS) imaging findings in adult Wilson disease (WD) have been explained in extensive details, a paucity of information currently exists regarding brain MRS imaging findings in pediatric WD. The purpose of this study was to clarify the role of brain MRS in detecting early metabolite abnormalities in children with WD. PATIENT AND METHODS A case-controlled prospective study included 26 children with WD and 26 healthy controls. All children were subjected to examination on a 1.5 T MRI scanner. The spectra of N-acetyl aspartate (NAA), choline (Cho), and creatine (Cr), as well as the metabolite ratios of NAA/Cho, NAA/Cr, and Cho/Cr, were measured and compared between two groups. RESULTS Eight patients revealed increased signal intensity in the basal ganglia at T1-weighted images. When compared with healthy controls, WD patients showed a significant decrease (p < 0.05) in NAA (63.8 ± 9.6 vs 97.6 ± 3.8), Cho (46.7 ± 8.9 vs 87.3 ± 4.7), Cr (44 ± 10.1 vs 81.9 ± 4.05), NAA/Cho (1.92 ± 1.2 vs 3.34 ± 0.55), NAA/Cr (1.29 ± 0.7 vs 2.46 ± 0.34), and Cho/Cr (0.78 ± 0.4 vs 2 ± 0.13). Patients complicated with liver cell failure showed a significant decrease in all previous parameters (p < 0.05) than patients without complications. Patients with mixed neurological and hepatic diseases showed a severe reduction in NAA, NAA/Cr, and NAA/Cho compared with patients with hepatic disease only. CONCLUSION MRS in pediatric WD detects early neurological changes even with normal MRI.
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Affiliation(s)
| | - Rania Refaat
- Department of Radio-diagnosis, Faculty of human medicine, Ain Shams University, Cairo, Egypt.
| | - Ayman F Ahmed
- Department of Radio-diagnosis, Faculty of human medicine, Zagazig University, Zagazig, Egypt.
| | - Hala Y Yousef
- Department of Radio-diagnosis, Faculty of human medicine, Zagazig University, Zagazig, Egypt.
| | - Ahmed Mohamed Alsowey
- Department of Radio-diagnosis, Faculty of human medicine, Zagazig University, Zagazig, Egypt.
| | - Maha Ibrahim Metwally
- Department of Radio-diagnosis, Faculty of human medicine, Zagazig University, Zagazig, Egypt.
| | - Sameh Abdelaziz Aly
- Department of Radio-diagnosis, Faculty of human medicine, Banha University, Banha, Egypt.
| | - Hatem M Hussien
- Department of Pediatrics, Faculty of human medicine, Zagazig University, Zagazig, Egypt.
| | - Hosam F El-Saadany
- Department of Pediatrics, Faculty of human medicine, Zagazig University, Zagazig, Egypt.
| | - Asghan A AlGhobashy
- Department of Pediatrics, Faculty of human medicine, Zagazig University, Zagazig, Egypt.
| | - Mohamed A Talat
- Department of Pediatrics, Faculty of human medicine, Zagazig University, Zagazig, Egypt.
| | - Mona M Amer
- Department of Neurology, Faculty of human medicine, Zagazig University. Zagazig, Egypt.
| | - Ashraf Mahrous Eid
- Department of Ophthalmology, Faculty of human medicine, Zagazig University, Zagazig, Egypt.
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Abstract
The potential use of adenosine in the treatment of hemorrhagic shock was evaluated in rabbits. Hemorrhagic shock was induced by bleeding the animals to a mean arterial blood pressure of 30-35 mmHg that was maintained for 2 hr. The intravenous infusion of 300 micrograms/kg/min adenosine for 1 hr, after reinfusion of the shed blood, was found to be capable of increasing the survival rate of rabbits subjected to hemorrhagic shock. In shocked rabbits, adenosine profoundly improved the postreinfusion depressed contractility of the heart, but it produced a decrease in the mean arterial blood pressure and heart rate. In the same animals, the plasma concentrations of glucose, lactate and inorganic phosphate, which were markedly elevated during shock, were returned back toward normal levels by the intravenous infusion of adenosine. Similarly the alteration that occurred in the plasma sodium, potassium and calcium levels during shock was corrected by adenosine. It is consequently concluded that the use of adenosine after shock improves tissue perfusion and enhances the functional recovery of cells by restoring their metabolic machinery and thereby improves the survival rate.
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Affiliation(s)
- A O Abdel-Zaher
- Department of Pharmacology, Faculty of Medicine, Assiut University, Egypt
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19
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Aly SA, Cranley B, Todds A. Nephrobronchocutaneous fistula. Ulster Med J 1994; 63:116-8. [PMID: 8658987 PMCID: PMC2449106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- S A Aly
- Daisy Hill Hospital, Newry, Co. Down, Northern Ireland
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Ahmed NI, Aly SA, Shaaban EM. The nurses' knowledge and attitudes about epilepsy. J Egypt Public Health Assoc 1994; 69:277-92. [PMID: 17265643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
This study aimed at the assessment of the nurses' knowledge and attitudes towards epilepsy. A sample consisting of 273 nurses working in different hospital departments, at three University hospitals in Tanta, Menoufiya and Zagazig was chosen. The results revealed a deficiency in the nurses' knowledge about epilepsy. However, they had a moderately positive attitude towards epilepsy. Although more than half of them considered epilepsy a mental illness, they agreed that epileptics must learn in special schools. It is recommended that all in-service training programs for nurses should emphasize epilepsy management, rehabilitation of epileptics, and how to change public attitudes towards epilepsy.
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Affiliation(s)
- N I Ahmed
- Department of Medical Surgical Nursing, HIN, Tanta University
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Shaaban EM, Aly SA, Ahmed NI, Mandil AM. Maternal approach to epileptic school-age children in Menoufiya and Zagazig: a comparative study. J Egypt Public Health Assoc 1994; 69:129-46. [PMID: 17265634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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Kirk SJ, Kelly SB, Aly SA, Sharma VK, Bateson PG, Panesar KJ. Laparoscopic cholecystectomy: experience in a district general hospital. Ulster Med J 1992; 61:3-7. [PMID: 1535742 PMCID: PMC2448780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In many centres laparoscopic cholecystectomy has become the procedure of choice for symptomatic gallbladder stones. By comparison with conventional cholecystectomy it appears to be associated with minimal morbidity, shorter hospital stay, earlier return to work and a better cosmetic result. The present study reviews the results of the first 50 laparoscopic cholecystectomies performed at Altnagelvin Area Hospital.
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Affiliation(s)
- S J Kirk
- Altnagelvin Area Hospital, Londonderry
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Aly SA, Udeala OK. Comparative evaluation of two direct compression lactose grades for pyridoxine hydrochloride tablets. Pharmazie 1988; 43:188-90. [PMID: 3380861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Fast flow lactose (FFL) and anhydrous lactose (AHL) were comparatively investigated for the manufacture of pyridoxine hydrochloride tablets. The results showed that drug/FFL formulations possessed better performance. Harder tablets were, however, compressed from AHL blends. Linear relationships which correlate tablet physical properties to excipient concentration in a given formulation were established. Tablet batches formulated with FFL dissolved in shorter times und showed better stability characteristics on aging.
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Affiliation(s)
- S A Aly
- Department of Pharmaceutical Technology and Industrial Pharmacy, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka
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Askar O, Aly SA. The veins of the foot. Surgical anatomy and its relation to disorders of the venous return from the foot. J Cardiovasc Surg (Torino) 1975; 16:53-63. [PMID: 1126985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Askar O, Kassem KA, Aly SA. The venographic pattern of the foot. J Cardiovasc Surg (Torino) 1975; 16:64-70. [PMID: 1126986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Askar O, Kassem KA, Aly SA. A clinico-radiological study of the "varicose foot". J Cardiovasc Surg (Torino) 1975; 16:71-8. [PMID: 1126987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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