Background Deep tissue Candida invasion represents a special entity among neonates with invasive candidiasis. We aimed to explore the risk factors and clinical outcomes for deep tissue Candida invasion among neonates with invasive candidiasis. Methods A retrospective data review of neonates admitted to NICU of Madinah maternity and children hospital, KSA from January 2012 to December 2019 was done. Data were analysed between infants with or without deep tissue candidiasis among infants with invasive candidiasis. Invasive candidiasis was defined as positive blood or catheter collected urine culture for Candida. Deep tissue Candida invasion was defined as an infection of the central nervous system, eyes, heart, skeletal system, lungs, liver or kidneys. Result A total of 14 (11%) out of 130 neonates with invasive candidiasis had deep tissue Candida invasion. Persistent positive blood culture for Candida [OR 15.2, 95% CI (2.0–114), p = .01], prematurity [OR 7.6, 95% CI (1.04–56.4), p = .04] and prolonged antibiotic duration [OR 1.3, 95% CI (1.02–1.6), p = .03] are independent risk factors for deep tissue Candida invasion. Deep tissue Candida invasion was associated with significantly higher rates of cerebral palsy, hydrocephalus, heart failure and longer length of hospital stay compared to infants without deep tissue invasion. Conclusion Persistent Candida growth in blood cultures, prematurity and long‐term antibiotic use are significant risk factors for deep tissue Candida invasion. Deep tissue Candida invasion is associated with prolonged hospital stay and higher neonatal morbidity.

Aim The aim of this study was to evaluate the long-term overall therapy outcomes and clinicopathological risk factors in patients with differentiated thyroid cancer (DTC) and iodine avid bone metastases. Methods Our study included 93 patients [female to male ratio (2:1)]. All patients were subjected to clinical examination, laboratory assessment, I-131 whole body scan, and neck ultrasound. Iodine avid metastases were treated with successive radioactive iodine-131 (RAI-131) doses. The overall response was defined as complete response (CR), incomplete response (IR) [partial response (PR) and stable disease (SD)], and progressive disease (PD). Results Fifty-four patients had follicular carcinoma and 39 with papillary type. Isolated bone metastases, bone and lung metastases, and multi-organ metastases were found in 45, 34, and 14 patients, respectively. The overall CR, PR, SD, and PD were found in 8.6%, 28%, 46.2%, and 17.2% patients, respectively. Adjunctive radiotherapy resulted in more CR, IR, and low PD rates compared to RAI-131 therapy (9.0%, 78.3%, 12.7% vs. 7.9%, 56.8%, and 23.7%, respectively) (P = 0.03). The overall survival rate was 88.2% and median follow-up period was 123 months. Female patients, papillary carcinoma, and single focal lesion had better overall response rate. Males, extrathyroidal extension, vascular invasion, and lymph nodes metastases had increased PD and decreased global response rates. Conclusion Despite of low CR rate (8.6%), most patients with DTC and iodine avid bone metastases had SD (46.2%) and long lived (88.2%). Adjunctive radiotherapy reduced PD and improved outcome. Males, extra thyroid extension and vascular invasion were bad prognostic factors.

Aim: The aim of the study is to evaluate the value of thyroid-stimulating hormone (TSH)-stimulated thyroglobulin (sTg) measurements by the end of the 1 st -year postablation in differentiated thyroid cancer (DTC) patients with biochemical non complete response (indeterminate and incomplete response). Patients and Methods: One hundred patients with DTC underwent near-total thyroidectomy and radioactive remnant ablation by iodine-131 (I 131 ) with regular follow-up every 6 months during the first 2 years and at 6–12-month intervals thereafter by I 131 whole-body scan (WBS), neck ultrasound, and sTg measurement in the hypothyroid state (TSH >30 mU/L). Patients were divided according to the imaging findings and sTg level into three groups: excellent response (ER) – no evidence of disease by imaging and sTg <1 ng/mL, indeterminate or acceptable response (AR) – nonspecific findings on imaging studies and sTg < 10 ng/mL, and incomplete response (IR) – patients with incomplete structural and/or incomplete biochemical response (sTg > 10 ng/mL). Results: The follow-up at 6-month postablation showed ER in 3 (3%) patients, AR in 29 (29%) patients, and IR in 68 (68%) patients. The second follow-up at 9–12-month postablation showed dramatic biochemical response with ER, indeterminate, and IR in 50 (50%), 34 (34%), and 16 (16%) patients, respectively, and 14 (14%) patient had structural recurrence. This change is highly statistically significant ( P = 0.00). In the last follow-up (ranges from 3 to 10 years), 53 (55.8%) patients achieved ER, 42 (44.2%) AR and no patient with non complete response. The change in patients with IR between the second and the last follow-up is also statistically significant ( P = 0.001). Conclusion: sTg measurement by the end of the 1 st year is more reliable in the follow-up of patients with DTC and biochemical non complete response and considered significant predictor of disease-free status. Patients with biochemical IR still have the chance to achieve ER or AR by the passage of time without additional therapies.

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Aim:This study aims to assess the diagnostic performance of 18F-fluorodeoxyglucose-positron emission tomography/computerized tomography (18FDG-PET/CT) compared to whole body (WB) magnetic resonance diffusion-weighted imaging (DWI) with background body signal suppression (MR/DWIBS) in lesions detection in patients with recurrent breast cancer.Materials and Methods:Twenty-three female patients with suspected breast cancer recurrence by clinical, laboratory, or conventional imaging underwent both 18FDG-PET/CT and WB MR/DWIBS. WB 18FDG-PET/CT was performed using the standard technique. WB MR/DWIBS acquired sequences were WB DWI with short tau inversion recovery (STIR), coronal T1, and coronal STIR. Both 18FDG-PET/CT and WB-magnetic resonance imaging/DWIBS were independently interpreted using visual qualitative and quantitative analysis. Pathological findings and combined clinical/radiological follow-up data were used as a reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated for both techniques.Results:PET/CT demonstrated higher specificity and sensitivity indices than MR/DWIBS in the detection of the nodal and distant lesions, while the latter displayed higher sensitivity in the detection of local breast lesions. The overall sensitivity, specificity, NPV, PPV, and accuracy of PET/CT were 84.8%, 86.3%, 90.4%, 78.7%, and 85.4% versus 82.1%, 78.0%, 85.2%, 74.0%, and 80.5% for MR/DWIBS. A high degree of agreement existed between PET/CT and MR-DWIBS.Conclusion:18FDG-PET/CT is more sensitive and has superiority in the assessment of nodal and distant lesions than DWIBS that has a potential superior role in the assessment of local breast lesions. DWIBS has a promising and helpful complementary tool for 18FDG-PET/CT in the evaluation of patients with proven malignancies.

Background: The coexistence of thyroid cancer (TC) and hyperthyroidism (HT) cause serious diagnostic, therapeutic and prognostic difficulties Fine-needle aspiration biopsy (FNAB) is considered as essential step in the checkup of the thyroid nodule. Aim of the work. Assessment of the clinical value of FNAB and to determine frequency of thyroid cancer in patients with autonomous toxic thyroid adenoma, before radioactive iodine therapy. Methodology: All patients underwent clinical examination, thyroid hormonal profile analysis, neck ultrasound, Tc-99 thyroid scan and Fine Needle Aspiration Biopsy (FNAB). Twelve Patients with positive, suspicious or nondiagnostic FNAB results underwent thyroidectomy and histopathological analysis. Results: This study included forty one patients, 23 females (56.1%) and 18 males (43.9%) with mean age 39.8 (±9.3) years. All patients have elevated T3, T4 and suppressed TSH. All patients underwent FNAB; 29 patients (70.7%) were negative, two patients (4.9%) had TC, one patient (2.4%) was suspicious and 9 patients (22%) were non-diagnostic. Twelve patients with positive, suspicious or non-diagnostic FNAB results underwent thyroidecetomy followed by histopathological examination of the surgical specimens that confirmed features of TC in two patients with positive FNAB and one patient with suspicious FNAB, in addition to another one patient with nondiagnostic FNAB. Thyroid cancer was found on 4 patients (9.76%), three patients had papillary thyroid cancer and the fourth had follicular form proved by surgery. Conclusion: Addition of FNAB to work up list of patients with autonomous toxic thyroid adenoma prior to radioactive iodine therapy has added value in detection of malignancy. However surgery is recommended to confirm or exclude malignancy in patients with suspicious or non-diagnostic FNAB results.

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Background/Objective Management of thyroid disorders depends on accurate clinical assessment, appropriate investigations and radionuclide imaging, which plays an established important role either qualitatively or quantitatively. The aim of this study was to assess the utility of the thyroid/salivary ratio (TSR) as an alternative to technetium-99m (Tc99m) pertechnetate thyroid uptake (TcU) percentage in the evaluation of thyroid function and in the same time to establish reference range for the thyroid uptake of Tc99m-pertechnetate and TSR among Egyptian populations. Patients and methods This retrospective study enrolled 270 patients, out of which 250 with different thyroid disorders and 20 without thyroid diseases, as a control group who all underwent full clinical examination, thyroid function tests and Tc99m pertechnetate thyroid scintigraphy. The TcU percentage and TSR were calculated and then correlated to the thyroid hormonal profile. Results The normal reference ranges of TcU and TSR were 0.75–3.5% and 1.25–4.8%, respectively. The sensitivity and specificity of TSR to diagnose hyperthyroidism were slightly lower compared with TcU (84.5 and 92.3% vs. 86.2 and 98.3%, respectively) at TSR cutoff value of more than 4.8 and TcU cutoff value of more than 3.5. Meanwhile, they had comparable sensitivity and specificity to diagnose hypothyroidism (86.0 and 93.3% vs. 86.5 and 94.5%) at cutoff values <0.75 and <1.25, respectively. Conclusion The current study established a reference range for TcU and TSR in our institution. TSR is comparable to TcU in the evaluation of thyroid function among hyper-and hypothyroid patients and TSR can be used in doubtful cases of mal-thyroid function for confirmation of the diagnosis.