Rapid Detection of Coronavirus (COVID-19) Using Microwave Immunosensor Cavity Resonator.

This paper presents a rapid diagnostic device for the detection of the pandemic coronavirus (COVID-19) using a micro-immunosensor cavity resonator. Coronavirus has been declared an international public health crisis, so it is important to design quick diagnostic methods for the detection of infected cases, especially in rural areas, to limit the spread of the virus. Herein, a proof-of-concept is presented for a portable laboratory device for the detection of the SARS-CoV-2 virus using electromagnetic biosensors. This device is a microwave cavity resonator (MCR) composed of a sensor operating at industrial, scientific and medical (ISM) 2.45 GHz inserted in 3D housing. The changes of electrical properties of measured serum samples after passing the sensor surface are presented. The three change parameters of the sensor are resonating frequency value, amplitude and phase of the reflection coefficient |S11|. This immune-sensor offers a portable, rapid and accurate diagnostic method for the SARS-CoV-2 virus, which can enable on-site diagnosis of infection. Medical validation for the device is performed through biostatistical analysis using the ROC (Receiver Operating Characteristic) method. The predictive accuracy of the device is 63.3% and 60.6% for reflection and phase, respectively. The device has advantages of low cost, low size and weight and rapid response. It does need a trained technician to operate it since a software program operates automatically. The device can be used at ports' quarantine units, hospitals, etc.

Gene expression analysis of invasive breast carcinoma yields differential patterns in luminal subtypes of breast cancer.

Breast cancer is a heterogeneous disease, and new biomarkers are needed for more accurate classification and prediction of prognosis. The goal of this study is to assess the expression of breast cancer classification genes, to identify new molecular signatures in different intrinsic subtypes of breast cancer and to correlate their expression with different clinical variables. The study included 84 female patients newly diagnosed with non-metastatic breast cancer at the outpatient clinic at the National Cancer Institute, Cairo University, Egypt. Detection of 17 breast cancer classification genes was done using RT-PCR in tumor and normal tissues. Estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki67 expression were assessed using IHC assay for intrinsic subtyping. Combined expression of FOXA1 and GATA3 was statistically higher in luminal subtypes in comparison to non-luminal subtypes. In Luminal A subtype; GRB7, EGFR, PTGS2, ID1, and KRT5 were significantly downregulated. FOXA1 and GATA3 were significantly upregulated in luminal B subtype, where EGFR and PTGS2 were significantly downregulated. While ESR1, EGFR, KRT5 and PTGS2 showed significantly low expression in tumor tissue in Her2 enriched subtype, TFF3 was significantly downregulated in triple negative subtype. GATA3 and FOXA1 expression exhibited significant correlation with tumor grade. Furthermore, GATA3, FOXA1, ESR1, and ID1 were also correlated significantly with staging of the tumor. Combined expression of ESR1, FOXA1 and GATA3 represents a molecular signature of luminal subtypes. Long term follow-up is needed to investigate the prognostic effect of breast cancer classification genes found in this study.

Inter-observer reproducibility of the Royal College system for reporting thyroid cytology: Experience of the Egyptian National Cancer Institute.

PURPOSE: To assess the inter-observer agreement between 3 cytopathologists of thyroid FNAC using Royal College of Pathology reporting system. PATIENTS AND METHODS: The study is a retrospective one conducted on 204 cases retrieved from the archives of the Cytology Unit, Pathology Department, National Cancer Institute, Cairo University during the time period from January 2016 to December 2016. Cases were diagnosed separately by 3 cytopathologists using the Royal College of Pathology classification system (RCPath), where Thy1, nondiagnostic; Thy2, nonneoplastic; Thy3a, atypical, Thy3f, follicular lesion; Thy4, suspicious of malignancy; and Thy5, malignant. Kappa statistics were used where combination of the agreement between the 3 observers simultaneously was done. RESULTS: There was a good overall agreement between the three observers regarding all categories (kappa statistics was 0.679). Perfect agreement was reported for Thy5 category (κ = 0.874), good agreement was observed for Thy1 and Thy2 (κ = 0.784 and 0.719, respectively). For Thy3a, Thy 3f and Thy 4, a moderate agreement was reported (κ = 0.407, 0.446 and 0.453 respectively). Combination of surgical categories (Thy3f, Thy4, and Thy5) achieved a good agreement (κ = 0.701) as well as for non-surgical categories (Thy1, Thy2, and Thy3a) (κ = 0.712). CONCLUSION: RCPath reporting system for thyroid FNAC is clinically applicable and can be used for differentiation between benign cases needing observation and follow up on one hand, and malignant cases requiring surgical intervention on the other. The least inter-observer agreement (moderate agreement) was detected for Thy3a, Thy3f and Thy4 categories, necessitating multidisciplinary team meeting before any clinical decision.

Can we apply the MRI BI-RADS lexicon morphology descriptors on contrast-enhanced spectral mammography?

OBJECTIVE:: To assess the feasibility of using the MRI breast imaging reporting and data system (BI-RADS) lexicon morphology descriptors to characterize enhancing breast lesions identified on contrast-enhanced spectral mammography (CESM). METHODS:: The study is a retrospective analysis of the morphology descriptors of 261 enhancing breast lesions identified on CESM in 239 patients. We presented the morphological categorization of the included lesions into focus, mass and non-mass. Further classifications included (1) the multiplicity for "focus" category, (2) the shape, margin and internal enhancement for "mass" category and (3) the distribution and internal enhancement for "non-mass" category. Each morphology descriptor was evaluated individually (irrespective of all other descriptors) by calculating its sensitivity, specificity, positive-predictive value (PPV) and negative-predictive value (NPV) and likelihood ratios (LRs). RESULTS:: The study included 68/261 (26.1%) benign lesions and 193/261 (73.9%) malignant lesions. Intensely enhancing foci, whether single (7/12, 58.3%) or multiple (2/12, 16.7%), were malignant. Descriptors of "irregular"-shape (PPV: 92.4%) and "non-circumscribed" margin (odds ratio: 55.2, LR positive: 4.77; p-value: <0.001) were more compatible with malignancy. Internal mass enhancement patterns showed a very low specificity (58.0%) and NPV (40.0%). Non-mass enhancement (NME) was detected in 81/261 lesions. Asymmetrical NME in 81% (n = 52/81) lesions was malignant lesions and internal enhancement patterns indicative of malignancy were the heterogeneous and clumped ones. CONCLUSION:: We can apply the MRI morphology descriptors to characterize lesions on CESM, but with few expectations. In many situations, irregular-shaped, non-circumscribed masses and NME with focal, ductal or segmental distribution and heterogeneous or clumped enhancement are the most suggestive descriptors of malignant pathologies. ADVANCES IN KNOWLEDGE:: (1) The MRI BI-RADS lexicon morphology descriptors can be applied in the characterization of enhancing lesions on CESM with a few exceptions. (2) Multiple bilateral intensely enhancing foci should not be included under the normal background parenchymal enhancement unless they are proved to be benign by biopsy. (3) Mass lesion features that indicated malignancy were irregular-shaped, spiculated and irregular margins and heterogeneous internal enhancement patterns. The rim enhancement pattern should not be considered as a descriptor of malignant lesions unless CESM is coupled with an ultrasound examination.

Efficacy and safety of dexmedetomidine added to caudal bupivacaine in pediatric major abdominal cancer surgery.

BACKGROUND: Caudal analgesia has been prolonged by the addition of various adjuvants. Dexmedetomidine is a highly selective alpha-2 agonist with sedative and analgesic properties. OBJECTIVE: To investigate the effect of addition of dexmedetomidine to 0.25% bupivacaine for caudal analgesia in children undergoing major abdominal cancer surgery. STUDY DESIGN: A randomized double-blind trial. SETTING: Academic medical center. METHODS: Forty pediatric patients, aged 3 - 12 years, weighting 10 - 40 kg, and of American Society of Anesthesiologists (ASA) physical status I and II scheduled for major abdominal cancer surgeries under general anesthesia combined with caudal analgesia were enrolled. They were randomly allocated into 2 groups: Group I (BD): (n = 20) received 1 mL/kg bupivacaine 0.25% with dexmedetomidine 1 µg/kg and group II (B): (n = 20) received 1 mL/kg bupivacaine 0.25%. Heart rate (HR), mean arterial pressure (MAP), and oxygen saturation (SPO2) were recorded for 120 minutes. Pain was assessed immediately postoperative and at hours 2, 4, 6, 12, 18, and 24 of postoperative period by Face, Legs, Activity, Cry and Consolability (FLACC) score. Time to first request for analgesia and total analgesic consumption in the first 24 hours were recorded. The level of sedation was recorded using Ramsay's sedation scale [Intravenous acetaminophen 15mg/kg (perfalgan, Squibb)]. Adverse effects were recorded and treated. RESULTS: There was significant reduction in FLACC score in group BD at 2, 4, 6, and 12 hours postoperatively compared to group B. At the eighteenth and twenty-fourth hour there was no significant difference. Time of the first rescue analgesic requirement was significantly prolonged in group BD compared to group B. The mean total consumption of rescue analgesia in the 24 hours of the postoperative period was significantly decreased in group BD (405.00 ± 215.03) mg when compared with group B (810.35 ± 200.93) mg. LIMITATIONS: This study is limited by its small sample size. CONCLUSION: Addition of dexmedetomidine (1 µg/kg) to caudal bupivacaine 0.25% (1 mL/kg) in pediatric major abdominal cancer surgeries achieved significant postoperative pain relief for up to 19 hours, with less use of postoperative analgesics, and prolonged duration of arousable sedation. Hemodynamic changes were statistically significant, yet of no clinical significance.

Dexmedetomidine as an adjunctive analgesic with bupivacaine in paravertebral analgesia for breast cancer surgery.

BACKGROUND: There is little systematic research on the efficacy and tolerability of the addition of adjunctive analgesic agents in paravertebral analgesia. The addition of adjunctive analgesics, such as fentanyl and clonidine, to local anesthetics has been shown to enhance the quality and duration of sensory neural blockades, and decrease the dose of local anesthetic and supplemental analgesia. OBJECTIVES: Investigation of the safety and the analgesic efficacy of adding 1 µg/kg dexmedetomidine to bupivacaine 0.25% in thoracic paravertebral blocks (PVB) in patients undergoing modified radical mastectomy. STUDY DESIGN: A randomized, double-blind trial. SETTING: Academic medical center. METHODS: Sixty American Society of Anesthesiologists physical status -I - III patients were randomly assigned to receive thoracicPVB with either 20 mL of bupivacaine 0.25% (Group B, n = 30), or 20 mL of bupivacaine 0.25% + 1 µg/kg dexmedetomidine (Group BD, n= 30). Assessment parameters included hemodynamics, sedation score, pain severity, time of first analgesics request, total analgesic consumption, and side effects in the first 48 hours. RESULTS: There was a significant reduction in pulse rate and diastolic blood pressure starting at 30 minutes in both groups, but more evidenced in group BD (P < 0.001). Intraoperative Systolic blood pressure showed a significant reduction at 30 minutes in both groups (P < 0.001) then returned to baseline level at 120 minutes in both groups. There was a significant increase in pulse rate starting 2 hours postoperative until 48 hours postoperatively in group B but only after 12 hours until 48 hours in group BD (P < 0.001). The time of the first rescue analgesic requirement was significantly prolonged in the group BD (8.16 ± 42 hours) in comparison to group B (6.48 ± 5.24 hours) (P = 0.04). The mean total consumption of intravenous tramadol rescue analgesia in the postanesthesia care unit in the firtst 48 hours postoperatively was significantly decreased in group BD (150.19 ± 76.98 mg) compared to group B (194.44 ± 63.91 mg) (P = 0.03). No significant serious adverse effects were recorded during the study. LIMITATIONS: This study is limited by its sample size. CONCLUSION: The addition of dexmedetomidine 1 µg/kg to bupivacaine 0.25% in thoracic PVB in patients undergoing modified radical mastectomy improves the quality and the duration of analgesia and also provides an analgesic sparing effect with no serious side effects.

On the significance of fuzzification of the N and m in cancer staging.

The tumor, node, metastasis (TNM) staging system has been regarded as one of the most widely used staging systems for solid cancer. The "T" is assigned a value according to the primary tumor size, whereas the "N" and "M" are dependent on the number of regional lymph nodes and the presence of distant metastasis, respectively. The current TNM model classifies stages into five crisp classes. This is unrealistic since the drastic modification in treatment that is based on a change in one class may be based on a slight shift around the class boundary. Moreover, the system considers any tumor that has distant metastasis as stage 4, disregarding the metastatic lesion concentration and size. We had handled the problem of T staging in previous studies using fuzzy logic. In this study, we focus on the fuzzification of N and M staging for more accurate and realistic modeling which may, in turn, lead to better treatment and medical decisions.

Age at diagnosis in women with non-metastatic breast cancer: Is it related to prognosis?

OBJECTIVE: Primary objective was to verify whether breast cancer patients aged less than 40 years at diagnosis have poorer prognosis than older patients. Secondary to assess prognostic factors influencing disease free survival. METHODS: 941 women were diagnosed with non-metastatic breast cancer at NCI, Cairo in 2003. Epidemiologic, clinico-pathological characteristics, treatment modalities and disease free survival were compared among the two age groups. Prognostic factors were evaluated for association with disease-free survival. RESULTS: One hundred-eighty-one patients (19.2%) were younger than 40 years and 760 (80.8%) were older. Older women presented with higher rates of comorbidities and younger women presented with more hormone non-responsive tumors. Young women presented with larger tumors pT4=13.8% compared to 8.6% in older women, yet not significant. Young women were treated with more conservative surgery, more adjuvant chemotherapy and radiotherapy while older women with more radical mastectomies and more hormonal treatment. Recurrence rates were significantly higher among young women 44.2% compared to 34.5% in older women. Five year disease free survival in young women was 38.9% ± 4.6% compared to 48.6% ± 2.5% with adjusted hazard ratio of 1.22 95% CI (0.91-1.64), p=0.19. Multivariate analyses identified positive axillary lymph nodes (pN2-pN3), larger tumor size (pT3-pT4), hypertension, lobular carcinoma type and lack of adjuvant systemic treatment as independent factors associated with poor DFS. CONCLUSION: Young women were not found to have poorer prognosis, yet they presented with more ER negative tumors. Most of women presented with advanced stage and young women had higher recurrence rates.

Role of Ki67 in predicting resistance to adjuvant tamoxifen in postmenopausal breast cancer patients.

INTRODUCTION: Breast cancer (BC) is a major health problem in Egypt and worldwide. Its prognosis depends not only on tumor stage but also on tumor biology. AIM: To correlate the expression of Ki67 with the clinical outcomes of early hormone-receptor positive postmenopausal BC patients who are receiving tamoxifen. METHODS: This cohort study included 70 patients. They were followed up for a minimum of 2 years. Ki67 was assessed on paraffin-embedded blocks using immunohistochemistry methods. RESULTS: The median Ki67 value was 22.5% (IQR, 10%-50%). Ki67 was significantly higher in patients with HER2 positive tumors compared to HER2 negative tumors. After a median follow up period of 53 months, 22 patients (31%) developed disease recurrence either loco-regional or distant in 5.7% and 30%, respectively. Recurrent patients had significantly higher tumor stage, nodal stage and Ki67 values compared to non-recurrent cases. The 2-, 3- and 5-year overall survival (OS) and disease-free survival (DFS) rates were 100% & 91%, 98% & 84% and 77% & 59%, respectively. DFS was significantly worse with higher TNM stage, lower ER expression and higher Ki67 values. OS was significantly worse in patients with Ki67 values ≥ 30%. Ki67 ≥ 30% was an independent predictor of recurrence, poor DFS and OS. CONCLUSION: High Ki67 expression is predictive of poor prognosis and of resistance to adjuvant tamoxifen therapy in postmenopausal BC. We recommend considering Ki67 as one of the risk factors that guide adjuvant treatment decisions.