Background: Care protocol for patients with chronic obstructive pulmonary disease is considered as a strategy for promoting their knowledge, practice and clinical outcomes. Aim: This study aimed to evaluate the effect of care protocol on knowledge, practice and clinical outcomes of patients with COPD through the following: A. Assessment of knowledge, practice and clinical outcomes of patients with chronic obstructive pulmonary disease (COPD). B. Developing and implementing care protocol for patients with COPD. C. Evaluating the effect of care protocol on knowledge, practice and clinical outcomes of patients with COPD. Methods: Study design: A quasi-experimental design was utilized to conduct this study. Setting: The study was conducted at chest department and outpatient clinic at Ain Shams University Hospitals. Subjects: A purposive sample of 50 patients with chronic obstructive pulmonary disease was included in the study. Data collection tools: (1) Patients' assessment sheet. (2) Patients' observational checklists. (3) Clinical outcomes assessment sheet. Results: There were statistically significant differences between mean scores of the pre and post test regarding patients' knowledge, practice and clinical outcomes except for respiratory muscle training. Conclusions: Application of care protocol for patients with COPD has positive effect on improving knowledge, practice and clinical outcomes regarding dyspnea, fatigue, sleep quality, mood. Recommendations: Applying care protocol for all patients with chronic obstructive pulmonary disease in the chest units and updating its content periodically in order to improve knowledge, practice and clinical outcomes for those patients.

Background Carcinoma of unknown primary (CUP) is a diagnostic and therapeutic challenge; correct diagnostic approach results in better outcomes in patients with brain metastasis. Whole body 18 F-FDG PET/CT is a helpful modality to detect the origin of primary tumor and assess metastasis in the rest of the body. We assessed the value of PET/CT in detection of unknown primary in 39 patients with brain metastases as initial presentation and detected its impact on their overall survival. Results PET/CT could correctly detected the primary tumor in 49% of patients which occurred mainly in the lung, 63% of patients had additional extracerebral metastatic sites mostly in lymph nodes. Specificity, sensitivity, and accuracy of PET/CT in CUP patients were 95%, 79%, and 87%, respectively. No significant difference was noticed in estimated overall survival time between patients with an identified primary tumor and patients with unidentified primary tumor. Conclusion PET–CT was a helpful non-invasive imaging modality in detecting primary in CUP patients with metastatic brain lesion. It helped in the diagnosis of unexpected extracerebral metastatic lesions. However, the identification of the primary tumor by PET/CT has no significant prognostic effect on patient overall survival.

Background: Helicobacter pylori (H. pylori) infection is an extremely prevalent infection that has been connected to a number of illnesses, including stomach cancer and peptic ulcer disease. Additionally, depression has been listed as a widespread, expensive, and 13% prevalent public health concern. Despite the substantial link between depression and H. pylori gastritis, few studies have looked at the connection between H. pylori infection and depression. Objective: In this study we aimed to assess the relation between depression and H. pylori infection. Patients and methods: This was a case control study that included 150 patients with and without H. pylori infection, patients were diagnosed by detection of H. pylori antigen in the stool, with assessment of presence and severity of depression in all patients using depression score using PHQ-9 SCORE (Preliminary Psychiatric Assessment Using Patient Health Questionnaire). Results: Comparing both groups revealed highly significant increase in PHQ-9 score in group 1 patients with positive H. pylori infection compared to group 2 patients with negative H. pylori infection with significant increase in the severity of depression among H. pylori positive group Conclusion: H. pylori infection was significantly associated with depression and it is presence is related to the severity of depression making assessment of the presence of gastrointestinal symptoms or dyspepsia is very important in patient with depression.

Background: Pancreatic malignancy is a rapidly growing cause of death in the world. Its survival rate is months even if discovered early. Aim of Study:We evaluated the correlations between PET/SUVs (Standard Uptake Values), clinical characteristics and cancer stem-like cells named aldehyde dehydrogenase 1 (ALDH1) in pancreatic cancer. We evaluated the diagnostic performance of SUV and its correlation with overall survival.Patients and Methods: Thirty-nine patients with pancreatic cancer were evaluated by PET/CT. The expression of ALDH1 was detected immunohistochemically in their cancer specimens. Results of PET/SUV were correlated with clinicpathological character, ALDH1 and overall survival.Results: PET/SUV was associated significantly with tumor size (p=0.027). No significant correlation with other clinicalpathological characteristics. PET/CT showed sensitivity= 81%, specificity=78% and accuracy=82%. PET/SUV reflected the expression level of ALDH1 with significant correlation (p=0.001). Patients with high SUV and high expression of ALDH1 had a worse median overall. Conclusion:PET-CT was a non-invasive imaging modality that helped in pancreatic cancer especially in doubtful tumors. PET/CT was helpful tool to detect lymph nodes invasion and distant metastasis. It was associated with the expression level of ALDH1. High SUV and high expression of ALDH1were significantly correlated with a worse clinical outcome. PET/SUV and Cancer stem cells may serve as significant prognostic factors in predicting outcomes in pancreatic cancer patients.

Background: Breast cancer is considered the most common malignancy in females and the second most common leading cause of cancer death after lung cancer. Color, power and pulsating Doppler ultrasonography are more sensitive in the evaluation of solid breast mass depending on tumor new blood vessels growth that plays an important role in the growth of the malignant lesions. Aim of Work:To study the vascular structure of solid breast mass and to detect the importance of reversed diastolic flow in detection of malignancy.Material and Methods: This study included 114 solid breast mass in 100 female patients. Color Doppler ultrasound was done for all patients. We studied the blood vessels of the mass and we analyzed the wave pattern and detected the value of reversed diastolic flow in detecting malignancy. Results:The vessels in malignant breast mass are of irregular caliber with central penetration while regular peripheral parallel vessels are suggestive of benignity also we found that reversed diastolic flow is significant sign of malignancy. Conclusion:Color Doppler ultrasound is helpful to detect the vascular pattern of solid breast mass. Hypervascular mass with reversed diastole is suggestive of malignancy especially if the invading vessel is central and of irregular shape while presence of peripheral parallel vessels is suggestive of benignity however color Doppler indices such as high RI alone is not good indicator of malignancy.