Amin, A., M. A. El-Kareem, and A. B. Yahia, "Influence of low grade exercise on skeletal scintigraphy using Tc-99m methylene diphosphonate.", Nuclear medicine review. Central & Eastern Europe, vol. 18, issue 2, pp. 61-4, 2015. Abstract

BACKGROUND: Tc-99m methylene diphosphonate [MDP] bone scan is the basis of the skeletal imaging in nuclear medicine being a highly sensitive tool for detecting bone diseases. Mechanical stimulation induced by low grade exercise or whole-body vibration appears to be advantageous regarding the maintenance and/or improvement of skeletal mass in humans. We aimed to assess the physiological influence of low grade exercise on the quality of skeletal scintigraphy using Tc-99m MDP.

MATERIAL AND METHODS: Tc-99m MDP bone scan was done for 92 volunteers [Group 1; G1]. Five days later, the same subjects were re-scanned [Group 2; G2] after an exercise on treadmill for 5 minutes. Image quality was assessed using quantitative measures whereby equal regions of interest (ROI) were drawn over the femoral diaphysis, and the contralateral adductor area. The total number of counts from the bone [B] ROI and soft tissue [ST] ROI was expressed as a ratio [B:ST ratio] and a mean value for each was established.

RESULTS: Statistically significant difference was found between the B:ST ratio means [p = 0.001] in G1 and G2.

CONCLUSION: This study raised a physiological influence of low grade exercise on the image quality of tc-99m MDP skeletal scintigraphy by increasing MDP osseous uptake.

Amin, A., H. Darweesh, and H. Attia, "The Utility of Tc-99m MDP Bone Scintigraphy for the Detection of Articular Involvement in Behçet's Disease", The Open Nuclear Medicine Journal, vol. 2, pp. 138-142, 2010. AbstractWebsite

Introduction: Behçet’s disease (BD) is a chronic relapsing inflammatory disease. 40-70% of BD patients display rheumatic features with a 9% incidence as an initial presentation. However, there are no pathognomonic laboratory tests in BD and the diagnosis depends on the occurrence and grouping of sufficient clinical manifestations to allow the physician to either suspect, or definitely diagnose the condition. Our aim was to assess the utility of Tc-99m methylene diphosphonate (Tc-99m MDP) bone scintigraphy for the detection of articular involvement in BD patients and its impact on disease activity & severity scoring.
Methods: 25 BD patients diagnosed according to the international study group criteria for BD diagnosis (ISG) [18 male, 7 female, mean age 32.44±7.78, disease duration 6.98±4.61year] were included and subjected to selected joint x-ray and bone scintigraphy.
Results: 25/25 was scintigraphically positive for arthritis [100%, 64%, 44%, 40%, 36% & 20% in wrist, Metacarpophalangeal, proximal interphalangeal (PIPs), distal interphalangeal (DIPs), Knees & ankles respectively]. 13/25 were clinically negative while scintigraphically positive for arthritis. 11/25 (44%) and 8/25 (32%) turned from inactive to active BD and from mild to moderate disease severity, based on their positive hand scintigraphy with treatment modification. 4/25 (16%) had recurrent oral ulcers with normal laboratory data and only positive hand scintigraphy; with follow-up they met ISG criteria.
Conclusion: skeletal scintigraphy is a simple diagnostic modality with a low radiation burden, when compared to conventional radiology. Hence, when used appropriately in the diagnostic algorithm of BD, bone scintigraphy can be used for detection of early joint involvement, assessment of the extent and activity status with guidance for the selected therapy.

Mohamed, R. H. A., H. S. Zayed, and A. Amin, "Renal disease in systemic sclerosis with normal serum creatinine.", Clinical rheumatology, vol. 29, issue 7, pp. 729-37, 2010 Jul. Abstract

Prognosis of systemic sclerosis largely depends on involvement of internal organs. The aim was to evaluate renal impairment in patients with systemic sclerosis by measuring the Glomerular filteration rate (GFR) and then calculating the GFR using the Cockgroft and Gault formula and the Modification of Diet in Renal Disease Equation (MDRD) formula. Thirty one scleroderma patients were recruited from the Rheumatology and Rehabilitation Department, Cairo University Hospitals, mean age 43.25 +/- 11.28 years, 31 healthy controls were included. Disease severity was done using Medsger score. GFR was measured using classical Gates method TC99mDTPA. The modified Cockcroft and Gault formula and equation 7 from the MDRD were used for calculation of GFR. All patients had within normal serum creatinine levels. A normal GFR (>89ml/min) was found in 45.1%. Gates method showed reduced GFR was reported in 54.9%. Stage II chronic kidney disease (60-89 ml/min) found 32.3%, and stage III (30-59 ml/min) in 22.6%. The formulae used showed reduction of GFR in 35.29% of those affected by the Cockcroft-Gault and in 41.17% of those affected using the MDRD. No correlation to patients' age, disease duration, or severity. A positive correlation was also reported between the presence of renal involvement and pulmonary vascular involvement p = 0.04. Gates method showed reduction of the GFR in 54.9% of the systemic sclerosis patients. The formulae used were not as precise as the measured GFR in diagnosing all cases with subclinical renal involvement. Patients with systemic sclerosis should be screened for renal involvement irrespective of disease severity or duration.

Zayed, H., D. Effat, Z. Nawito, A. A. Abdou, M. N. E. Din, S. El-Refaei, M. Amin, Y. Mohamed, A. Amin, A. Wafie, et al., "Silent central nervous system involvement in Egyptian Behçet's disease patients: clinical, psychiatric, and neuroimaging evaluation.", Clinical rheumatology, vol. 30, issue 9, pp. 1173-80, 2011 Sep. Abstract

Behçet's disease (BD) is an idiopathic multisystem disorder. Involvement of CNS occurs in 4-48% of cases. This study was designed to evaluate the prevalence of subclinical neuropsychiatric affection in asymptomatic Egyptian BD patients using psychometric tests and brain imaging with single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI), also to assess possibly associated clinical predictive variables. Twenty-five BD patients without overt CNS involvement and ten healthy controls matched for age, education, and sex completed a comprehensive neuropsychological battery including Hamilton scales for anxiety and depression and Wechsler memory scale-revised. Disease activity was assessed using Behçet's Disease Current Activity Form (BDCAF). SPECT was done for all subjects, and 12 patients underwent brain MRI. Compared to controls, 23 (92%) and 24 (96%) patients had anxiety and depression scores respectively above normal range; also, BD patients had significantly lower memory quotient (MQ). SPECT revealed abnormalities in 16/25 (64%), while in 3/12 patients (25%), MRI was abnormal. Subjects with abnormal SPECT had significantly higher ages than those with normal SPECT (P = 0.02) and were more frequently males (P = 0.03). No statistically significant differences between cases with normal or abnormal SPECT were found regarding disease duration, frequency of headache, BDCAF, frequency of active eye disease, major vascular involvement, mean Hamilton anxiety and depression scores, and mean MQ. Early diagnosis of neurological involvement in BD is important in reducing or preventing complications. Neuropsychiatric evaluation and HMPAO brain SPECT were found to be useful for detecting subclinical neurological abnormalities in BD patients.

Nawito, Z., A. Amin, S. A. El-Fadl, and K. A. E. Einen, "Sicca complex among Egyptian patients with chronic hepatitis C virus infection.", Clinical rheumatology, vol. 30, issue 10, pp. 1299-304, 2011 Oct. Abstract

The objective of this study was to assess the prevalence of sicca complex (SC) in patients with chronic hepatitis C virus (HCV) infection and its association with clinical and laboratory features of liver disease. Subjective and objective criteria of xerophthalmia and xerostomia were investigated in 120 HCV Egyptian patients. The lacrimal gland function was assessed by: tear film break-up time and lid parallel conjunctival folds test (LIPCOF), dacroscintigraphy (DSG) for lacrimal drainage and that of salivary glands by sialoscintigraphy. Sixty six of 120 patients (55%) had SC; all (100%) were proved to have xerostomia by sialoscintigraphy and xerophthalmia detected by ophthalmologic tests. Using dacroscintigraphy all SC patients (100%) were positive for lacrimal drainage abnormalities. Only 10.1% were symptomatic for SC. None of our patients had anti-Ro or anti-La antibodies. The presence of SC was associated with older age (r = 0.28, p = 0.00), female gender (p = 0.001), cirrhosis (r = 0.34, p = 0.00), thrombocytopenia (r = -0.72, p = 0.00), and rheumatologic manifestation (p = 0.000), but not with viral load (r = 0.19, p = 0.06). DSG showed significant statistical correlation with ophthalmologic tests (r = 0.87, p = 0.00). High prevalence of SC in HCV Egyptian patients was detected. LIPCOF and DSG are objective and noninvasive methods for early diagnosis of xerophthalmia and assessment of the nasolacrimal drainage, respectively. Hindrance of lacrimal drainage proved by DSG was frequently encountered in HCV patients with SC (100%) and strongly correlated with xerophthalmia.

Fouda, R., H. Ammar, E. Sobhy, and A. M. Amin, "Unusual cause of pericardial effusion", BMJ Case Reports, vol. 2012, 2012. AbstractWebsite

A 65-year-old Egyptian lady suffering from non-alcoholic liver cirrhosis was referred to our unit for evaluation of a massive pericardial effusion. Few weeks before presentation, she suffered from progressive abdominal distention and dyspnoea. She denied fever, rigors or other cardiorespiratory symptoms. Examination revealed shrunken liver, spleenomegaly and ascites. Chest was clear to auscultation and heart sounds were distant. Chest radiograph showed cardiomegaly and clear lung fields. Abdominal ultrasound confirmed the results of abdominal examination. Transthoracic echocardiogram (TTE) revealed a massive pericardial effusion (PEF) and rheumatic mitral stenosis. Chest tomography showed PEF and clear lung fields. One litre of exudate was removed via TTE-guided needle pericardiocentesis. A pericardio-peritoneal shunt was suspected, which was confirmed via a radioisotopic study. This case is among very few cases that reported PEF in a cirrhotic ascetic patient secondary to a radio-isotopically confirmed pericardio-peritoneal shunt in the literature.

Amin, A., M. Amin, and E. Ahmed, "Low FDG Metabolic Activity of Loco-Regional Recurrence in Thyroid Cancer Patients; Is Iodine-131 has a Potentiality?", The Open Nuclear Medicine Journal, vol. 6, pp. 12-16, 2014. AbstractWebsite

Purpose: To investigate the impact of quantitative FDG-Metabolic activity of non-iodine avid Loco-regional recurrence [LRR; thyroid recurrence and/or cervical node metastasis] on therapy selection in thyroid cancer patients with elevated thyroglobulin [TG].

Methods: Forty thyroid cancer [33 papillary and 7 follicular] patients who underwent FDG PET/CT were studied [with TSH>30 mU/L]. Those with only LRR were classified according to maxSUV [cut-off level 5] into high and low metabolic activity lesions [HMA &LMA]; their therapy outcome was compared with histopathologic findings and/or follow-up routine evaluation.

Results: Only LRRs was found in 20 patients [17 papillary and 3 follicular] with diagnostic accuracy of FDG PET/CT of 100 %. 14/20 patients belonged to HMA where surgical neck exploration was done while in the remaining 6 patients with LMA empirical high dose of radioactive iodine-131 was given based on the assumption of the presence of a mixture of undifferentiated and differentiated thyroid cancer cells; though their post-therapy scan was negative but declined TGlevels were elicited in their follow-up [base-line 27.7±2.4 and at follow-up 6.8±1.4 ng/ml; P 0.02].

Conclusion: Max-SUV based classification of non-iodine avid LRR might improve the diagnostic accuracy FDG PET/CT in a therapeutically relevant way in DTC-patients by precisely localizing them with subsequent surgical guidance in HMA lesions while those with LMA could benefit from further RA-131 therapy.

Amin, A. M., and Z. O. Nawito, "Preclinical coronary endothelial dysfunction in Egyptian Behçet’s disease patients; Tc-99m sestamibi pharmacological Gated-SPECT, is it a useful screening tool?", The Egyptian Rheumatologist, vol. 35, no. 3, pp. 159 - 166, 2013. AbstractWebsite

Introduction Behçet’s disease (BD) is an idiopathic multisystem disorder. Cardiac involvement [cardio-BD] occurs in 7–60% of \{BD\} patients. Technetium 99m-Methoxyisobutyl isonitrile (Tc-99m sestamibi) is a myocardial perfusion imaging agent that is used for evaluation of the coronary flow. Aim of the work To evaluate the usefulness of Dipyridamole pharmacological stress test in conjunction with Tc-99m sestamibi cardiac gated single photon emission computed tomography (GSPECT) to investigate the prevalence of subclinical coronary endothelial dysfunction [SCED] in asymptomatic Egyptian \{BD\} patients; also to assess possibly associated clinical predictive variables. Patients and Methods Twenty-five \{BD\} patients without overt cardiac involvement and fifteen healthy controls matched for age, \{BMI\} and sex were included. Database included full history, clinical examination, relevant laboratory tests, and Tc-99m sestamibi myocardial \{GSPECT\} with coronary angiography [CAG] in \{GSPECT\} positive cases. Disease activity was assessed using Behçet’s Disease Current Activity Form (BDCAF). Results \{SCED\} detected by reduced flow or left ventricular dysfunction (LVD) or both was found in 13/25 [52%] of BD-patients [12 males and 1 female] vs. 1/15 [6.7%] of controls [P < 0.0001] with normal CAG. Subjects with positive \{GSPECT\} had significantly older age [P = 0.01] and longer disease duration (P = 0.02) and were more frequently males (P < 0.0001) than those with negative GSPECT. No statistically significant differences between cases with negative and positive \{GSPECT\} were found regarding other clinical or laboratory parameters. Conclusion Tc-99m sestamibi \{GSPECT\} could be a useful screening tool for detection of \{SCED\} in \{BD\} patients, so early prophylactic measures and therapy modifications could be considered.

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