Comparison of the diagnostic performance of Magnetic Resonance Imaging (MRI), ultrasound and mammography for detection of breast cancer based on tumor type, breast density and patient's history: A review.

OBJECTIVE: Breast cancer is the most common malignancy in women. Mammography and ultrasound are commonly used in a clinical environment as the first choice for breast cancer detection. Magnetic Resonance Imaging (MRI) has been reported to reveal additional information. In the following review MRI, Ultrasound (US) and Mammography (MM) are all compared in terms of their diagnostic performance on breast cancer detection, depending on tumor type, breast density and patient's history. KEY FINDINGS: Evaluating each modality alone, MRI provided an overall sensitivity and specificity of 94.6% (range 85.7%-100%) and 74.2% (range 25%-100%) respectively, while mammography showed that the overall sensitivity was at 54.5% (range 27%-86.8%) and specificity was 85.5% (range 62.9%-98.8%). The overall sensitivity and specificity of ultrasound was 67.2% (range 26.9%-87.5%) and 76.8% (range 18.8%-96.9%). When combining the results of all three techniques, it resulted in a sensitivity of 97.7% (range 95%-100%) and a specificity of 63.3% (range 37.1%-87.5%). In addition, contrast-enhanced mammography (CE-MM) and MRI (CE-MRI) illustrated an overall sensitivity and specificity for CE-MM was 90.5% (range 80.9%-100%) and 52.6% (range 15%-76.1%) and for CE-MRI, the overall sensitivity and specificity was 91.5% (range 89.1%-93.8%) and 64.7% (range 43.7%-85.7%). CONCLUSION: As modalities alone, the highest sensitivity has been observed for MRI and the lowest sensitivity for mammography regardless breast type, density, and history. Sensitivity is even more increased from the combination of US + MRI or MM + MRI or MRI + MM + US. The specificity seems to be affected by the size, type of the tumor and patient's history, however based on breast density, the highest specificity was observed by US alone. IMPLICATIONS FOR PRACTICE: Breast cancer screening is of outmost importance and identifying the best technique will improve cancer management. Combining techniques increases diagnostic ability compared with using modalities alone. CE-MM can be a viable option in dense breast tissue when there are contraindications to MRI as it also has high sensitivity based on the type of breast cancer.

Vitamin D and bone health status in beta thalassemia patients-systematic review.

Thalassemia is a chronic congenital disease characterized by a combination of endocrine and metabolic disorders. Bone disease is a very common complication related to the poor absorption of calcium, the secondary chronic renal disease with low vitamin D, as well as multiple endocrine risk factors. The aim of this systematic review was to estimate the prevalence of vitamin D deficiency in thalassemia, as well as its association with osteoporosis/low bone mass. A systematic review was carried out using PubMed/Medline, Cochrane, and EBSCO databases. The methodological quality of the included studies was assessed with the validated Newcastle-Ottawa Quality Assessment Scale adapted for cross-sectional studies and cohort studies respectfully and the Cochrane Collaboration for clinical trials. After application of predetermined exclusion criteria compatible with the PICOS process, a total of 12 suitable articles were identified. The prevalence of vitamin D deficiency varied considerably. Only five of the reviewed studies examined the correlation between vitamin D levels and BMD of which just three showed a statistically significant positive association of mild/moderate grade. Vitamin D deficiency is a common comorbidity in patients with thalassemia. However, both its prevalence and its severity vary considerably in different populations, and existing evidence is insufficient to conclude whether vitamin D supplementation is also associated with BMD improvement in this special population group.

Eccentric exercise in ischemic cardiac patients and functional capacity: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Eccentric (ECC) exercise is an "economical" type of exercise with low energy requirements and does not cause early fatigue. Therefore, it is used for cardiac patients, who have low physical activity and exercise intolerance, as an easier kind of training. OBJECTIVE: This systematic review aimed to investigate the efficacy of ECC exercise for functional capacity (FC) in patients with ischemic heart disease. DESIGN: Systematic review. METHODS: MEDLINE via PubMed and EBSCO databases were searched for articles of randomized controlled trials of adults with ischemic heart disease who underwent ECC training as compared with other forms of exercise (concentric exercise) or no exercise and assessed FC. The methodologic quality of studies was assessed by the PEDro scale. A meta-analysis was performed with sufficient homogeneity between at least 2 studies in the pre-defined comparisons. RESULTS: Four studies, investigating a total of 99 subjects, met the inclusion criteria. The results of the studies did not clearly indicate whether ECC exercise could improve FC better than traditional forms of exercise. However, the small number of studies and their methodologic weaknesses do not allow for drawing firm conclusions. CONCLUSIONS: We found contradictory results about the effectiveness of ECC as compared with concentric exercise in terms of FC in ischemic cardiac patients. Further investigation with well-designed randomized trials is needed to determine the effectiveness of this kind of exercise for FC in such patients.