Second-hand smoke (SHS) exposure is a major public health concern. Pregnant women and children are a priority population for tobacco control efforts because second-hand smoke (SHS) exposure during pregnancy/childhood poses serious risks to foetal/child health. Due to strong cultural constraints against women smoking in many Middle Eastern countries, the prevalence of tobacco smoking is higher among men than women, which puts non-smoking women and children on risk of exposure to SHS. The Middle Eastern countries are Bahrain, Cyprus, Egypt, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Palestine, Qatar, Saudi Arabia, Syria, Turkey, United Arab Emirates, and Yemen. In Egypt, daily SHS exposure among pregnant non-smoking women and children is estimated to be more than 50% at home and more than 70% in public places. The aim of the current thesis is to investigate the experience of SHS exposure among pregnant women and children in Middle Eastern countries with focus on Egypt, barriers and facilitators to reduce it, and to come up with recommendations on how to reduce this exposure. Three studies were conducted to achieve this aim. The first study aimed to identify, appraise, and synthesize the evidence related to experiences and views of parents, children, and professionals on the prevention of second-hand smoke exposure to women and children in Middle Eastern countries by conducting a qualitative systematic review. Six databases and grey literature were searched from inception to January 2021 to identify published and unpublished studies. No language restrictions were applied. The JBI guidelines …

Abstract

Purpose 

To assess the value of posttherapy ^99mTc-pentavalent dimercaptosuccinic acid (DMSA-V) brain SPECT/CT in patients with brain glioma.

Methods 

Patients with pathologically or radiologically proven glioma were prospectively enrolled in this study. ^99mTc-DMSA-V brain SPECT/CT images were acquired at 120–180 min after i.v. injection of 555–740 MBq of ^99mTc-DMSA-V. Three nuclear medicine physicians blindly interpreted the scans visually as positive or negative for residual/recurrent disease. Agreement between two or more readers was considered a consensus. The composite reference standard was considered based on subsequent clinical/neuroimaging follow-up or histopathology whenever available. Overall survival (OS) was calculated from the date of initial diagnosis till the death or the date of last follow-up.

Results 

Thirty-four patients (18 males and 16 females; mean age 37.7 ± 16 years) were enrolled in this study. Interreader agreement between the readers ranged from 0.71 to 0.82. Based on the composite reference standard, residual/recurrent disease was confirmed in 16 patients, whereas 18 patients were negative for disease. Consensus reading of ^99mTc-DMSA-V SPECT/CT accurately diagnosed 13 true positive (sensitivity 81%) and 17 true negative scans (specificity 94%). After a median follow-up of 22.9 months, 7/14 patients with positive ^99mTc-DMSA-V SPECT/CT brain readings died compared to 4/20 with negative readings. The median survival was 24.1 months for the positive group and was not reached for the negative group.

Conclusion 

Posttherapy brain SPECT/CT scanning with ^99mTc-DMSA-V is a noninvasive, reliable, and specific tool for evaluation of patients with brain glioma after definitive therapy. Scan positivity was associated with poor OS.

Objectives: To investigate the effect of serum glucose level and other confounding factors on the variability of maximum standardized uptake value (SUVmax) in normal tissues within the same patient on two separate occasions and to suggest an ideal reference tissue.

Materials and methods: We retrospectively reviewed 334 18F-FDG PET/CT scans of 167 cancer patients including 38 diabetics. All patients had two studies, on average 152 ± 68 days apart. Ten matched volumes of interest were drawn on the brain, right tonsil, blood pool, heart, lung, liver, spleen, bone marrow, fat, and iliopsoas muscle opposite third lumber vertebra away from any pathological 18F-FDG uptake to calculate SUVmax.

Results: SUVmax of the lungs and heart were significantly different in the two studies (P = 0.003 and P = 0.024 respectively). Only the brain uptake showed a significant moderate negative correlation with the level of blood glucose in diabetic patients (r = -0.537, P = 0.001) in the first study, while the SUVmax of other tissues showed negligible or weak correlation with the level of blood glucose in both studies.The liver showed significant moderate positive correlation with body mass index (BMI) in both studies (r = .416, P = <0.001 versus r = 0.453, P = <0.001, respectively), and blood pool activity showed significant moderate positive correlation with BMI in the first study only (r = 0.414, P = <0.001). The liver and blood pool activities showed significant moderate negative correlation with 18F-FDG uptake time in first study only (r = -0.405, P-value = <0.001; and r = -0.409, P-value = <0.001, respectively).In the multivariate analysis, the liver showed a consistent effect of the injected 18F-FDG dose and uptake duration on its SUVmax on the two occasions. In comparison, spleen and muscle showed consistent effect only of the injected dose on the two occasions.

Conclusion: The liver, muscle, and splenic activities showed satisfactory test/retest stability and can be used as reference activities. The spleen and muscle appear to be more optimal reference than the liver, as it is only associated with the injected dose of 18F-FDG.

Keywords: 18F-FDG PET/CT; Blood glucose; Intrapatients; Normal tissues.

Aim To evaluate the prognostic value of postoperative Tc-99m pertechnetate scanning in patients with differentiated thyroid cancer (DTC).
Method Patients with pathologically proven low or intermediate-risk DTC were enrolled in this study. Postoperative Tc-99m pertechnetate scintigraphy was performed 20 min after IV of 185 MBq of Tc-99m pertechnetate Positive thyroid residual uptake was characterized as higher Tc-99m pertechnetate uptake at the thyroid bed than the surrounding background’s activity. A negative residual was considered if there was no definite abnormal radioactivity at the thyroid bed. Follow-up by thyroglobulin, thyroglobulin antibodies (Tg Abs), neck ultrasound (US) and diagnostic I-131 WBS (Dx WBS) were considered the reference standard. Successful ablation outcome was considered if there was free Dx WBS, stimulated serum thyroglobulin < 1 ng/ml with negative Tg Abs, and free US
Result Two hundred and two patients, mean age; of 38.8 years were retrospectively recruited in this study. Positive residual uptake at the thyroid scan was detected in 131 patients whereas the remaining 71 patients had no detectable uptake. According to the reference standard we encountered 114 and 88 cases with successful ablation and unsuccessful ablation respectively, Tc-99m pertechnetate scanning successfully detected 63 true positive and 46 true negative cases giving 72% sensitivity, 40% specificity, 48% positive predictive value, and 56% negative predictive value.
Conclusion In low- and intermediate-risk DTC patients; despite the relatively high sensitivity of postoperative Tc-99m pertechnetate thyroid scan, it has low specificity and low negative predictive value so it cannot be used to predict the ablation outcome. 
Keywords: ablation outcome, basal thyroglobulin, DTC, Tc-99m pertechnetate, thyroid scanning