Results of parasitic infections, as revealed by urine and stool examination was significant (P less than 0.05) in 43.3% of patients suffering from different malignant diseases and non significant (P greater than 0.05) in 29.3% of leprosy patients compared to 22% in control subjects. The most prevalent parasites were E. histolytica and G. lamblia. Cryptosporidium occysts were not detected. By stool examination and culture, S. stercoralis larvae were detected only in the malignancy group. The most common parasites occurring concomitantly were A. duodenale and S. stercoralis. By the IFAT, strongyloidiasis gave significantly higher positive results in the malignancy group than in the leprosy and control groups. IFAT for toxocariasis, showed highly significant positivity in the leprosy group and significantly positivity in the malignancy group. For toxoplasmosis, it showed highly significant positive results in both leprosy and malignancy groups. Eosinophilia was significantly more prominent among malignancy patients and insignificant among those with leprosy. Parasitic infection detected by urine and stool examination among patients with eosinophilia was found in 76% of the malignancy patients and in 66.7% of the leprosy patients.

Strongyloides stercoralis

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Doppler Ultrasonography on Small Joints of Hands and Feet to Assess Subclinical Affection in Patients with Psoriasis

QJM (2024)

M S Mohamed Dalia Fayez Mohamed Amina Badr Eldin Abdelaziz Noran O. El-Azizi E. S. I. Mohamed

Abstract Background Psoriasis, a systemic inflammatory disease, often manifests as plaque psoriasis, affecting 80-90% of patients. Psoriatic arthritis (PsA) diagnosis relies on CASPAR criteria, with ultrasound, especially power Doppler, proving valuable in assessing severity and treatment response. PsA causes deformity, dysfunction, and significantly impairs patients' quality of life. Aim of the Work To asses subclinical affection of peripheral joints in psoriatic patients without symptoms of arthropathy. Patients and Methods A cross-sectional study conducted at Ain Shams University Hospital involved 70 psoriasis patients recruited from dermatology clinics. The study, adhering to ethical standards, utilized comprehensive methods, including medical history, clinical examinations, routine laboratory tests, and musculoskeletal ultrasound with power Doppler. The cross-sectional design allowed assessment of various aspects of psoriasis and its associated conditions. Results This cross-sectional study of 70 psoriatic patients revealed that musculoskeletal involvement was more prevalent in females (57.7%) and those with a BMI >24 (kg/m2). Higher PASI scores (>5) correlated with increased risk. Treatment with topical steroids and methotrexate showed positive associations. In multivariate analysis, female gender and PASI score >5 remained significant predictors of musculoskeletal affection in psoriatic patients (p < 0.05). Conclusion The study underscores the significance of evaluating musculoskeletal issues in psoriatic patients. Female gender, higher BMI, smoking, and elevated PASI scores were linked to musculoskeletal involvement. Treatment with topical steroids and methotrexate correlated with such issues. Female gender and higher PASI scores were independent predictors of musculoskeletal concerns.

Subclinical infection

Affection

10.1093/qjmed/hcae175.407

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A207 POST-COLONOSCOPY COLORECTAL CANCERS IN ALBERTA: ROOM FOR QUALITY IMPROVEMENT

Journal of the Canadian Association of Gastroenterology (2018)

M S Mohamed Daniel Sadowski Dylan Johnson Clarence Wong

Post-colonoscopy colorectal cancer (PCCRC) is an indicator of colonoscopy quality and can happen as a result of technical factors surrounding the procedure such as inadequate bowel preparation, incomplete examination, missed or partly resected early lesions and failure to adhere to follow-up guidelines. There is a gap in our knowledge of the prevalence and root causes of PCCRC in Alberta, which are essential for quality improvement interventions The aim of this study was to find out the prevalence and the factors associated with the development of PCCRC from a population based perspective. This study was carried out in Alberta, which has a population of 1.8 million people older than age 39. 100,000 colonoscopies are done in the province annually. Centralized population-based data is available through the Alberta Cancer Registry (ACR), National Ambulatory Care Reporting System (NACRS), Discharge Abstract Database (DAD), and the Alberta Ambulatory Care Reporting System (AACRS). All initial cases of CRC appearing in the ACR during 2013 were linked to the NACRS, DAD and AACRS databases to determine dates and characteristics of all antecedent colonoscopies. Health record of the retrieved cases were reviewed. The study authors according to a structured algorithm reviewed an abstract of each case. Cases were classified according to a set of predetermined root causes 1278 patients > 39 years of age were diagnosed with CRC in 2013 and had a colonoscopy identified by the database linkage. 146 CRC cases were diagnosed based on colonoscopy that was performed > 6 months but < 60 months after index colonoscopy. Cases were classified to root causes (See Table 1). A total of 71 colonoscopists had at least one missed cancer with one colonoscopist missed 5 cancers This study provides a rational basis for case exclusion as well as systematic categorization of PCCRC root causes. This approach can be used to obtain PCCRC data over longer periods of time and to get a more accurate estimate of its prevalence. The root causes identified in this study indicate that there is room for improvement in colonoscopy quality as well as for enhancement of clinical care pathways Table 1 Table 1 None

10.1093/jcag/gwy009.207

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A62 POST COLONOSCOPY COLORECTAL CANCERS IN ALBERTA. A PROCESS FOR IDENTIFYING TRUE CASES

Journal of the Canadian Association of Gastroenterology (2018)

M S Mohamed Dylan Johnson Daniel Sadowski Clarence Wong

Determining Post Colonoscopy Colorectal Cancer (PCCRC) rates is one of the most important measures of colonoscopy quality. Most commonly, PCCRCs are the result of technical factors surrounding the colonoscopy such as inadequate bowel preparation, incomplete examination, missed early lesions and failure to adhere to follow-up guidelines. As these factors are amenable to quality interventions, we set out to identify PCCRC cases from a population perspective with a view to calculating incidence rates. Our objective was to develop a framework for data gathering and analysis in order to identify PCCRC cases and rates in Alberta in order to obtain a clearer understanding of the underlying causes of PCCRC where potential quality interventions might be applied. This was a retrospective population based review of all cases of colorectal cancer (CRC) diagnosed in Alberta in 2013. Data from the Alberta Cancer Registry (ACR) was linked to the Discharge Abstract Database (DAD), the National Ambulatory Care Reporting System (NACRS) and Alberta Ambulatory Care Reporting System (AACRS) databases to determine the timing of antecedent colonoscopies. We defined a PCCRC as a case identified in the ACR with ICD-10 codes for colorectal cancer with an antecedent colonoscopy greater than 6 months but less than 3 years prior to the diagnosis of CRC. Individual chart reviews were carried out to exclude high-risk groups such as IBD or genetic syndromes and to determine lesion location. Before a PCCRC rate could be calculated, we identified that the initial data linking process provided a number of cases that required further in depth review to determine if they met inclusion and exclusion criteria. Subsequently, through an iterative process of chart review, we developed a decision analysis framework (see Figure1), that provided a rational basis for case exclusion as well as systematic categorization of PCCRC root causes. Our analysis also identified areas for future quality improvement initiatives: such as the failure to arrange follow-up after poor bowel preparation or advanced lesions. We also identified cases where access to timely care resulted in the development of a PCCRC. Attempts to identify cases of PCCRC through database linkage identifies cases that require in depth analysis to determine eligibility. We have developed an algorithm that provides a rational basis for case exclusion as well as systematic categorization of PCCRC root causes. None

10.1093/jcag/gwy008.063

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Role of Pet/Ct In Follow Up of Post Therapeutic Colorectal Cancer

QJM (2020)

M S Mohamed M. A. Abo El Nasr Samer Malak Botros Abeer Abd El Maksoud Hafez

Abstract Background Colorectal cancer (CRC) is one of the most common malignancies worldwide and is a major health problem in developed countries with local and distant recurrences develops in 30–50% of patients during follow-up after primary surgery. Aim of Work The present study is aiming at emphasizing the role of PET/CT in Follow up of patients with colorectal carcinoma after treatment, as well as detection of local recurrence and distant metastasis. Methods The study included 25 patients with past history of colorectal cancer, they underwent PET/CT examination with the following protocol: Patients were fasting for at least 6 hrs before undergoing scanning. A standard dose of 1-1.5 mCi/kg of F-FDG was intravenously injected 45-60 mins before imaging then initially low dose CT was performed for attenuation correction. After that PET emission scanning was performed immediately after the CT. This was followed by diagnostic CT using IV contrast administration and hyperosmolar oral contrast (diluted mannitol solution) to achieve bowel distension. All data acquired a combined PET/CT in-line system. Results The study showed that there is significant paired differences between the number of local lesions as well as metastatic deposition detected in the initial and follow up PET/CT. Conclusion FDG PET/CT is extremely useful for therapy response assessment due to its capacity to help distinguish between residual metabolically active tumor and areas of necrosis and fibrosis, thus identifying which of these patients have achieved satisfactory functional remission and which one of them needs further treatment.

Primary tumor

10.1093/qjmed/hcaa068.014

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Predictive clinical and laboratory factors in the diagnosis of temporal arteritis.

PubMed (2002)

M S Mohamed T Bates

Surgeons are frequently called upon to perform temporal artery biopsy in patients suspected of having temporal arteritis. In this study, we have attempted to identify clinical and laboratory features that may predict the results of temporal artery biopsy for the diagnosis of temporal arteritis. The medical records of patients undergoing temporal artery biopsy over a 10-year period in one hospital were reviewed. Details of presenting features were recorded and comparisons made between biopsy-positive and biopsy-negative patients. Of 59 patients who underwent temporal artery biopsy, the records of 51 patients were located. Of these, 17 patients had positive biopsy specimens and 33 had negative biopsies. In one patient, no temporal artery was found in the biopsy specimen. In the biopsy-positive patients, 69% had an erythrocyte sedimentation rate of greater than 50 mm/h compared to 31% of biopsy negative patients (P = 0.03). With regard to the other clinical and laboratory parameters that were evaluated, no statistically significant differences were found between biopsy-positive and biopsy-negative patients.

Arteritis

Temporal artery

Erythrocyte sedimentation rate

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Serum Selenium Status in Egyptians Patients who had Graves’ Disease with and without Ophthalmopathy

QJM (2024)

Ghada Hasanin M S Mohamed Maram Mohamed Maher Hanan Mahmoud Ali Hany Khairy Mansour

Abstract Objective Selenium is effective in improving quality of life and reducing the progression of active Graves’ orbitopathy. The effect of correcting relative selenium deficiency on improving Graves’ orbitopathy is unknown, as baseline selenium levels have not previously been measured. The study aims to determine whether serum selenium levels are reduced in patients with Graves’ disease with orbitopathy (GO) compared with without orbitopathy (GD). Design A prospective, case–control study performed between 2019 and 2021 at endocrine and ophthalmology clinics in Ain SHams University, Cairo. Subjects A total of 75 subjects, 25 as control and a total of 50 patients with Graves’ disease participated in the study: 25 with Graves’ orbitopathy and 25 without Graves’ orbitopathy. Measurements Serum selenium levels in all groups. Results Mean serum selenium levels were significantly lower in GO (16.6 +- 7.5 ng/ml) than in GD (42.9 +- 8.2 ng/ml) with (P < 0.001). Mean selenium levels appeared to decrease in parallel with increasing severity of GO; selenium level was 30-55 ng/ml in GD, 21-28ng/ml in mild GO, 18-22 ng/ml in moderate GO and 5-16 ng/ml in severe GO (P < 0.001). Conclusion Serum selenium levels are lower in patients with GO compared with GD in an Egyptian study population with marginal selenium status. selenium deficiency may be an risk factor for orbitopathy in patients with Graves’ disease.

10.1093/qjmed/hcae070.301

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