Preservation of heritage buildings in Alexandria, Egypt: an application of heritage digitisation process phases and new documentation methods.

Background: Throughout the history of the city, the architecture of Alexandria, Egypt, has been in contact with world cultures, especially those of the Mediterranean sphere. Alexandria is rich with cultural features dating back seven thousand years. In Alexandria, the heritage value of the city has decreased because there is no suitable documentation system for these more recent assets. The development of a new technique for preserving heritage buildings is required. For example, image- based techniques can gather data using photography, panoramic photography, and close-range photogrammetry. In this research, we primarily seek to implement Heritage Digitisation Process Phases (HDPP) and establish new documentation methods in architectural conservation and built-heritage preservation, i.e., Virtual Reality (VR) and Website Heritage Documentation (WHD). Methods: The methodology is designed to preserve and manage cultural heritage using HDPP for the promotion of heritage building preservation in Alexandria. Results: The results show that the application of HDPP has led to the creation of a digital database about the Société Immobilière building, which was chosen as a case study for this research. Conclusions: Implementation of HDPP and usage of new documentation methods i.e., VR and WHD create a digital path to help strengthen its image and connect the place to users, recreational areas are created to communicate and explore the city's architectural history.

Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin.

BACKGROUND: A set of enduring conditions have been reported in the literature involving persistent sexual dysfunction after discontinuation of serotonin reuptake inhibiting antidepressants, 5 alpha-reductase inhibitors and isotretinoin. OBJECTIVE: To develop diagnostic criteria for post-SSRI sexual dysfunction (PSSD), persistent genital arousal disorder (PGAD) following serotonin reuptake inhibitors, post-finasteride syndrome (PFS) and post-retinoid sexual dysfunction (PRSD). METHODS: The original draft was designed using data from two published case series (Hogan et al., 2014 and Healy et al., 2018), which represent the largest public collections of data on these enduring conditions. It was further developed with the involvement of a multidisciplinary panel of experts. RESULTS: A set of criteria were agreed upon for each of the above conditions. Features of PSSD, PFS and PRSD commonly include decreased genital and orgasmic sensation, decreased sexual desire and erectile dysfunction. Ancillary non-sexual symptoms vary depending on the specific condition but can include emotional blunting and cognitive impairment. PGAD presents with an almost mirror image of unwanted sensations of genital arousal or irritability in the absence of sexual desire. A new term, post-SSRI asexuality, is introduced to describe a dampening of sexual interest and pleasure resulting from a pre-natal or pre-teen exposure to a serotonin reuptake inhibitor. CONCLUSIONS: These criteria will help in both clinical and research settings. As with all criteria, they will likely need modification in the light of developments.

Hypocupraemia-induced anaemia, sensory ataxia and cognitive impairment secondary to zinc-containing dental adhesive.

A 67-year-old man presented with 5 months of worsening memory impairment and sensory gait ataxia on the background of symptomatic anaemia. He experienced falls, agitation and became socially withdrawn over 3 weeks, resulting in hospital admission. On examination, he had sensory gait ataxia consistent with a dorsal column syndrome. He scored 13/30 on the Montreal Cognitive Assessment. Serum analysis showed normocytic anaemia and leucopenia, severe hypocupraemia, reduced caeruloplasmin and normal zinc levels. Overuse of zinc-containing denture cream was the cause of excess zinc ingestion and resultant copper deficiency, leading to blood dyscrasia and myelopathy. The cream was withdrawn and intravenous and then oral copper supplementation was implemented. Direct questions with regard to excess zinc in the diet and serological testing of copper and zinc should be considered in any patient with a dorsal column syndrome, particularly with concurrent anaemia. Copper deficiency may also have a role in exacerbating pre-existing cognitive impairment.

Different 18 F-FDG PET parameters for the prediction of histological response to neoadjuvant chemotherapy in pediatric Ewing sarcoma family of tumors.

BACKGROUND: The histological response to neoadjuvant chemotherapy (NAC) in pediatric patients with Ewing sarcoma family of tumors (ESFT) can predict the disease-free survival. Therefore, a noninvasive method for response assessment is needed. Using the currently established imaging modalities, mass reduction does not always correlate with the percentage of necrosis. OBJECTIVE: To determine the potential role of 18 fluorine-labeled fluoro-2-deoxyglucose positron emission tomography (18 F-FDG PET) metabolic parameters in the prediction of poor histological response to NAC in pediatric patients with ESFT. METHODS: Thirty-six patients who were treated with NAC and surgery at the Children's Cancer Hospital, Egypt, were prospectively included in this study. All patients underwent two studies; a PET/CT study before NAC and another one after NAC completion. Metabolic PET parameters were measured in each study. The ability of each of these parameters, their pretreatment and pre-local control values, as well as the percentage reduction between their pretreatment and pre-local control values, were evaluated to differentiate between good and poor responders using the histological response as a standard reference. RESULTS: Neither the pretreatment value nor the percentage reduction of any of the measured PET parameters predicted poor histological response. After NACcompletion, metabolic tumor volume (MTV) at the threshold of an SUV of 2.5 isocontour (MTV(2.5)post ), MTV at the threshold of hepatic reference SUVmean (MTV(HR)post ), and total lesion glycolysis at the threshold of hepatic reference SUVmean (TLG(HR)post ) predicted poor histological response (P  = 0.006, 0.018, and 0.003, respectively). The cutoff values of 90% reduction of TLG(HR) and maximum standardized uptake value (SUVmax)post ≤2.5 could differentiate between good and poor responders. CONCLUSION: FDG PET parameters can predict poor histological response to NAC in ESFT patients. MTV and TLG at the thresholds of an SUV of 2.5 isocontour and hepatic reference SUVmean are the two most promising thresholds in predicting the response of patients. The cutoff value of SUVmaxpost ≤2.5 predicts poor histological response.

Can FDG-PET replace biopsy for the evaluation of residual tumor in pediatric mature B-cell non-Hodgkin lymphoma?

INTRODUCTION: The aim of our study is to evaluate the role of 18 F-labeled fluorodeoxy glucose positron emission tomography (18 FDG-PET) scan for the detection of viable residual mass in pediatric mature B-cell non-Hodgkin lymphoma (NHL). This study also aims to detect the negative predictive value, positive predictive value (PPV), sensitivity, and specificity of 18 FDG-PET. PATIENTS AND METHODS: A retrospective, cross-sectional nonrandomized study was carried out. We included all patients with newly diagnosed mature B-cell NHL treated at the Children Cancer Hospital Egypt during the period between July 2007 and the end of May 2018. Patients were included in the study if they (a) had a residual tumor mass, (b) underwent an 18 FDG-PET scan, and (c) had a pathologic documentation of this residual tumor. Patients were followed up till June 2019. RESULTS: Thirty-six patients were included, for whom 39 biopsies were performed. Mean age was 7.7 years. Median follow-up period was 52.8, range 6.1 to 117 months.18 FDG-PET scan was positive (Deauville score 3, 4, or 5) in 24 of 39 patients (61.5%), while it was negative (Deauville score 1 or 2) in 15 patients (38.5%). Positive 18 FDG-PET scan and biopsy were performed in 15 of 39 samples (38.4%; true positive, TP), while they were both negative in 13 samples (33.3%; true negative). Nine patients (23%) had positive scan and a negative biopsy (false positive), while 2 patients had negative uptake and a positive biopsy (false negative, FN)). Sensitivity of the 18 FDG-PET scan was 88.2% and specificity was 59.1%. PPV was 62.5% and NPPV was 86.6%. CONCLUSION: Changing therapy on the basis of a positive finding alone at the time of evaluation is not recommended. FN results exist, so biopsy confirmation is required to avoid the missing refractory disease. If negative, 18 FDG- PET can replace a biopsy if the latter is inaccessible or carries an unnecessary risk.

Productivity of 18F-FDG-PET/CT Diagnostic Tool in the Management of Pediatric Lymphoblastic Lymphoma.

BACKGROUND: Lymphoblastic lymphoma (LL) comprises approximately 20% of childhood non-Hodgkin lymphoma (NHL); however, few studies had investigated the role of 18F-FDG-PET/CT in pediatric LL patients. We aim in this study to assess the role of 18F-FDG-PET/CT in the initial staging of newly diagnosed pediatric patients with LL as well as in the assessment of response after induction chemotherapy. PATIENTS AND METHODS: A prospective study enrolled biopsy proven newly diagnosed pediatric LL patients presenting in the Children Cancer Hospital Egypt (CCHE) during the period from October 2014 to October 2016. 18F-FDG-PET/CT was done initially before therapy and after induction chemotherapy in all patients. The patients were followed until the end of April 2018 (mean 23.5 months). RESULTS: All lymphoma involvement lesions (n = 43) were FDG avid and the intensity of nodal FDG uptake was variable. Two patients (11%) had bone marrow (BM) involvement by < 25% blast cells with corresponding positive BM focal uptake in 18F-FDG-PET/CT (SUVmax = 4 and 4.5). Evaluation post induction phase; CT detected 8 residual lesions in 8 patients (44.4%), while 18F-FDG-PET/CT detected only 3 Deauville-positive residual lesions in 3 patients (16.6%). No intensification of therapy was done in all post-induction positive patients. Repeated 18F-FDG-PET/CT at week 18 for post-induction patients revealed cleared all Deauville-positive residual lesions. On the other hand, repeated CT at week 18 detected regression but still residual in 4/8 (50%) post-induction CT lesions with clearance of the rest (50%). CONCLUSION: In initial staging, 18F-FDG-PET/CT is a useful tool for disease extent evaluation of pediatric LL. Moreover, it could provide a diagnostic hint for BM involvement. 18F-FDG-PET/CT done after induction therapy has a good negative predictive value with higher specificity than CT alone, but is not an indication for treatment intensification due to false positive results. However, larger sample size is required for better conclusion.

Bilateral Fat Containing Lumbar Hernia: A Case Report and Literature Review.

BACKGROUND Lumbar hernias continue to be rare and challenging regarding optimal treatment protocols. While computed tomography scan is considered the best imaging modality for assessment, we think there is a role for ultrasound in establishing a diagnosis seeking proper management and avoiding complications. CASE REPORT We present the case of an 84-year-old Saudi female who was known to have multiple chronic illnesses with bilateral flank swellings that were diagnosed as bilateral noncomplicated lumbar hernias which was treated conservatively with no complications. CONCLUSIONS Since the reported case is rarely encountered by surgeons, a low threshold to diagnosis is required. Finally, there is no consensus on management, and further studies to further investigate lumbar hernias are needed.

To Whom Thrombus Aspiration May Concern?

BACKGROUND: Thrombus aspiration for ST-segment elevation myocardial infarction (STEMI) may improve myocardial perfusion. However, these favourable results called into a question by data indicating not only a lack of efficacy but a risk of potentially deleterious complications. AIM: To assess the effect of thrombus aspiration during the primary percutaneous coronary intervention (PPCI) on procedural angiographic results, stent characteristics, and major adverse cardiac and cerebrovascular events (MACCE). METHODS: All consecutive STEMI patients candidate for PPCI and admitted to Critical Care Department, Cairo University hospitals, managed either by thrombectomy before primary PCI (if thrombus score ≥ 3) or conventional PPCI, Six hundred seven subjects were enrolled in the study divided into Group with thrombectomy before PPCI (107 subjects, 18%), and group with Conventional PCI (500 subjects, 82%). ST-segment resolution, peak CK-MB, TIMI score, thrombus score, and MBG were assessed; stent number, diameter, length and stented segment were reported and follow up MACCE was reported (in hospital and 1-year post-intervention). RESULTS: Mean values for peak CKMB were less in thrombectomy group (228 ± 174 I/U vs 269 ± 186 I/U, p = 0.04), ST segment resolution ≥ 70% occurred in {63 subjects (58.9%) vs 233 (46.6%), p = 0.001} in thrombectomy vs conventional group respectively. TIMI score pre procedure was zero in (102 subjects (95%) vs 402 (80.4%), p = 0.001), while TIMI III post procedure was reported in (100 subjects (93.4%) vs 437 (87%), p = 0.06), MBG mean values were (2.4 ± 0.6 vs 2.0 ± 1, p = 0.001), thrombus score was higher in thrombectomy group (4.6 ± 0.4 vs 0.8 ± 1.7, p = 0.001) in thrombectomy vs conventional group respectively. Direct stenting was { 34 patients (31%) vs 102 patients (20%), p = 0.05}, mean stent diameter (2.7 ± 1.3 mm vs 3.5 ± 1.3 mm, p = 0.3), mean stent length was (19.9 mm ± 10 versus 22.7 mm ± 8 in p 0.01). mean stent number was (1.0 ± 0.5 vs 1.2 ± 0.6, p = 0.001), mean stented segment was (22.5 ± 13.5 vs 28.5 ± 15.2 mm, p = 0.001) in thrombectomy vs conventional group respectively. MACCE in hospital were reported in {9 subjects (8.4%) vs 70 (14%), p = 0.07)}. Follow up MACCE after 1 year reported in {6 subjects (5.6 %) vs 80 (16 %), p 0.= 4} in thrombectomy vs conventional group respectively. CONCLUSION: Thrombus aspiration before primary PCI (in a selected group with thrombus score ≥ 3) improves myocardial perfusion, suggested by better ST-segment resolution, TIMI flow, less peak CKMB and MBG, associated with a higher rate of direct stenting, shorter stent length, stented segments and less number of stents. Although thrombus aspiration was done in more risky patients (higher thrombus score) MACCE (in hospital and 1 year follow up) showed no statistical difference.

Perforated mucocele of the appendix in the left upper quadrant: A challenging anatomy and an improvised surgical technique.

INTRODUCTION: Pseudomyxoma peritonei (PMP) is a feared complication of appendicular mucocele perforation. Although a rare disease, its major sequel mandates recognition and early intervention. Intestinal malrotation is mostly asymptomatic in adults. Its significance arises when it complicates another coinciding condition by confusing the presentation, leading to delay in diagnosis and treatment. PMP and incidental finding of gut malrotation in adults are two rare events, and the chance of both occurring in the same patient is very slim. This can complicate the clinical picture and lead to devastating outcomes. PRESENTATION OF THE CASE: We present a case of PMP in a patient with gut malrotation, managed with cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC). DISCUSSION: Management with CRS/HIPEC has been found to improve outcomes for patients with PMP. However, the extensive disease and abnormal anatomy of the patient in our report proposed unique intraoperative challenges. Preserving part of the colon was possible with an improvised surgical technique that we used which proved to be safe and effective. CONCLUSION: Early recognition and consideration of uncommon but serious surgical conditions are essential for improved patient outcomes. To our knowledge, this is the first report in the English literature that describes the use of CRS/HIPEC for PMP in a case of intestinal malrotation. This improvised surgical technique was found to be safe and can provide a surgical solution for preserving part of the colon in selected patients.

Mortality Prediction of Microalbuminuria in Septic Patients.

BACKGROUND: Huge number of pro-inflammatory and anti-inflammatory markers is produced during the process of sepsis. Its mortality prediction value needs to be determined. AIM: To assess the prognostic value of Albumin creatinine ratio (ACR) in septic patients and its ability to predict mortality in comparison with Acute physiology and chronic health evaluation II score (APACHE II). METHODS: Seventy-five Septic patients were included within 24 hours of sepsis diagnosis and were admitted to the intensive care unit (ICU). ACR values were obtained within 6 hours of ICU admission for all patients. Prognostic scoring systems [APACHE II and Sequential organ failure assessment (SOFA) scores] were calculated. RESULTS: Twenty percent of enrolled patients died within 28 days of hospital admission. ACR was significantly higher in non-survivor in comparison to survivors (55.1 ± 20.5 versus 30.2 ± 35.7, p = 0.006). ACR ≥ 40 (mg/gm creatinine) was the cut-off point for predicting mortality with a sensitivity of 90.7% and specificity of 71.8% with total accuracy of 66% and AUC 0.75 (CI 0.62-0.88). Mean APACHE II score was significantly higher in non-survivors than survivor groups (21.4 versus 10.8, p < 0.001). ACR was positively correlated with highest SOFA score (r = 0.3, P < 0.05). CONCLUSION: ACR is a simple prognostic marker in septic patient and could be used as a mortality predictor, particularly in early (within 6 hours) septic patients.

Considerations for the use of a loading dose of diazepam for the treatment of benzodiazepine dependence. / Consideraciones respecto al uso de dosis de carga de diazepam para el tratamiento de la dependencia a benzodiacepinas.

Letter to the editor.

Carta al director.

Stent boost enhancement compared to intravascular ultrasound in the evaluation of stent expansion in elective percutaneous coronary interventions.

BACKGROUND: Stent underexpansion is a major risk factor for in-stent restenosis and acute in-stent thrombosis1Intravascular ultrasound (IVUS) is one of the standards for detection of stent underexpansion (de Feyter et al. 1999; Mintz et al., 2001). StentBoost (SB) enhancement allows an improved angiographic visualization of the stent (Koolen et al., 2005). AIM OF WORK: Comparison of stent expansion by IVUS and SB enhancement and detection of value of SB to guide dilatation post stent deployment. METHODOLOGY: IVUS, SB enhancement and QCA were done in 30 patients admitted for elective stenting procedures .We compared measurements of mean ±standard deviations of (Max SD, Min SD, Mean SD, stent symmetry index) using IVUS, SB and QCA after stent deployment and after postdilatation whenever necessary to optimize stent deployment. The Stent symmetry index was calculated [(maximum stent diameter minus minimum stent diameter) divided by maximum stent diameter]. RESULTS: The Max SD was (3.45 ± 0.62 vs 3.55 ± 0.56 vs 2.97 ± 0.59) by IVUS vs SB vs QCA respectively. Max SD was significantly higher by IVUS vs QCA (p .009) and between SB vs QCA (p .001) while there was nonsignificant difference between IVUS vs SB (p .53). The Min SD was (2.77 ± 0.53 vs 2.58 ± 0.56 vs 1.88 ± 0.60) by IVUS vs SB vs QCA respectively. Min SD was significantly higher by IVUS vs QCA (p .001) and between SB vs QCA (p .001) while there was nonsignificant difference between IVUS vs SB (p .07). The stent symmetry index was (0.24 ±0.09 vs 0.34 ± 0.09 vs 0.14 ±0.27) by IVUS vs SB vs QCA respectively. It was significantly higher by IVUS vs QCA (p .001) and between SB vs QCA (p .001) while there was nonsignificant difference between IVUS vs SB (p .32). SB was positively correlated with IVUS measurements of Max SD (p < .0001 & r 0.74) and Min SD (p < .0001 & r 0.68). QCA was positively correlated with IVUS measurements of Max SD correlation (p < .0001 & r 0.69) and Min SD (p < .0001 & r 0.63). QCA was positively correlated with SB measurements of Max SD (p < .0001 & r 0.61) and Min SD (p .003 & r 0.49). CONCLUSIONS: StentBoost enhancement has superior correlations for stent expansion measured by IVUS when compared with QCA. SB enhancement improved stent visualization and identification of stent underexpansion to guide stent postdilatation.

Radiosynthesis and modified quality control of O-(2-[18F]fluoroethyl)-L-tyrosine ([18F]FET) for brain tumor imaging.

O-(2-[18F]fluoroethyl)-L-tyrosine ([18F]FET) is the most promising radio-labeled amino acid tracer for brain tumor imaging due to the limitation of 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) and L-methyl-[11C]methionine (11C-MET). However, it has some limitations in radiosynthesis and related quality control that make it less frequently used in many PET centers, in this study, we report a new modification of [18F]FET production using a commercially available fully automated GRP SCINTOMICS module overcoming some of the existing limitations along with a suggestion of a simplified quality control procedure with special focus placed on enantiomeric and radiochemical purity. ([18F]FET) was produced in high radiochemical and enantiomeric purity more than 99% and non-decay corrected yield 25±5% in about 55min.