Treatment Approaches Research Articles

Mechanism of protective actions of sparsentan in the kidney: lessons from studies in models of chronic kidney disease.

Simultaneous inhibition of angiotensin II AT1 and endothelin ETA receptors has emerged as a promising approach for treatment of chronic progressive kidney disease. This therapeutic approach has been advanced by the introduction of sparsentan, the first dual AT1 and ETA receptor antagonist. Sparsentan is a single molecule with high affinity for both receptors. It is US Food and Drug Administration approved for immunoglobulin A nephropathy (IgAN) and is currently being developed as a treatment for rare kidney diseases, such as focal segmental glomerulosclerosis. Clinical studies have demonstrated the efficacy and safety of sparsentan in these conditions. In parallel with clinical development, studies have been conducted to elucidate the mechanisms of action of sparsentan and its position in the context of published evidence characterizing the nephroprotective effects of dual ETA and AT1 receptor inhibition. This review summarizes this evidence, documenting beneficial anti-inflammatory, antifibrotic, and hemodynamic actions of sparsentan in the kidney and protective actions in glomerular endothelial cells, mesangial cells, the tubulointerstitium, and podocytes, thus providing the rationale for the use of sparsentan as therapy for focal segmental glomerulosclerosis and IgAN and suggesting potential benefits in other renal diseases, such as Alport syndrome.

Treatment With Topical Ivermectin 1% Once a Month to Control Demodex Blepharitis

Purpose: The study aimed to assess the effectiveness of a monthly application of topical 1% ivermectin cream, for 3 months, to the eyelids and eyelids margin, accompanied by gentle squeezing of meibomian glands and microexfoliation to the base of eyelashes, in the management of Demodex blepharitis. Methods: Thirty-eight patients diagnosed with Demodex blepharitis based on the presence of sleeves at the base of the eyelashes, telangiectasias, and signs of local inflammation with at least 4 Demodex mites observed at the lash roots were enrolled. Treatment involved applying 1% ivermectin topical cream using an eyelash brush in circular motion, gradually moving toward the eyelid margin. The procedure was repeated several times over 10 min by applying more cream. Each patient was evaluated before each treatment and 1 month after completion of the 3-month period. Results: Significant improvements in symptoms and signs were observed, with the disappearance of cylindrical sleeves on the base of the eyelashes, telangiectasias, signs of inflammation, and a significant decrease in night itching. The Schirmer test showed no changes, while the tear breakup time test exhibited slight yet statistically significant enhancement. No adverse events were reported during the study. Conclusions: The results of this investigation establish that Demodex blepharitis can be effectively managed by the application of 1% ivermectin cream once a month over a three-month period. This treatment approach, in conjunction with the gentle squeezing of meibomian glands and eyelid margin microexfoliation to the base of the eyelashes, resulted in the disappearance of objective indicators, such as cylindrical sleeves and telangiectasia, along with a significant reduction in nocturnal itching.

Uveal melanoma incidence and survival analysis in Portugal between 2013 and 2022

PurposeThis study aims to provide a comprehensive overview of the clinical characteristics and epidemiology of uveal melanoma (UM) in the Portuguese population, evaluated at the National Reference Centre (NRC). MethodsA prospective observational study was conducted, involving patients consecutively diagnosed with UM at the Portuguese NRC between July 2013 and December 2022. The study collected data on demographic and tumour characteristics, clinical staging according to the American Joint Committee on Cancer (AJCC), treatment approaches, local disease control, patient survival, and the occurrence of distant metastases. ResultsThe study included a total of 316 patients, 53.8% female. The mean age at diagnosis was 61.8±14.2 years, and 75.0% of patients presented with symptoms. The mean annual age-adjusted incidence of uveal melanoma in Portugal between 2014 and 2022 was 2.4 cases per million (95% confidence interval [CI]: 2.1–2.8). For choroidal/ciliary body tumours, the overall cumulative survival and distant metastases-free survival (DMFS) rates at 5 years were 84.9% (95% CI: 78.7–91.1) and 79.4% (95%CI: 72.8–86.0), respectively. Notably, higher AJCC stages at presentation, the need for enucleation, and increased tumour thickness were associated with lower DSS and DMFS rates. ConclusionThis study represents the most extensive analysis of UM epidemiology within the Portuguese population. The findings underscore the importance of early diagnosis and treatment in UM, as lower AJCC stages and smaller tumour thickness at diagnosis correlate with improved DSS and DMFS.

Effectiveness of giving dragon fruit and ambon banana to increase hemoglobin levels in anemic adolescent girls

Background: Anaemia is a common health problem among adolescent girls, especially in areas with limited access to nutritious food. One of the efforts to overcome anaemia is to increase the consumption of iron-rich fruits, such as dragon fruit and ambon banana. Objective: to evaluate the effectiveness of dragon fruit and ambon banana administration in increasing haemoglobin levels in anaemic adolescent girls Method: Qualitative research combines observational and interventional approaches. The research sample amounted to 2 adolescent female respondents. Instrument of treatment activities using a checklist sheet on elevated haemoglobin levels. Results: An increase in haemoglobin levels was obtained in adolescents given dragon fruit juice, where the first week was 10.1 g / dl, the second week was 11.2 g / dl, and the fourth week was 12.3 g / dl. There was a slightly slower increase in haemoglobin levels in adolescents who were given Ambonese bananas in the first week of 10.2 g / dl, the second week of 10.8 g / dl, and the fourth week of 11.3 g / dl. Conclusion: Respondents who consume dragon fruit increase haemoglobin levels faster than bananas. It is expected to be used as an alternative midwifery care for the midwife profession by giving dragon fruit juice to increase haemoglobin levels. Teenagers are advised to maintain a balanced diet by consuming fruits rich in iron and nutrients, such as dragon fruit, ambon, bananas, and other essential nutrients. By maintaining a balanced diet and increasing the consumption of iron-rich fruits, adolescents can improve their haemoglobin levels and maintain overall body health.

Positron emission tomography guided synergistic treatment of melanoma using multifunctional zirconium-hematoporphyrin nanosonosensitizers

Sonodynamic therapy (SDT) has emerged as a useful approach for tumor treatment. However, its widespread application is impeded by poor pharmacokinetics of existing sonosensitizers. Here we developed a metal-organic nanoplatform, wherein a small-molecule sonosensitizer (hematoporphyrin monomethyl ether, HMME) was ingeniously coordinated with zirconium, resulting in a multifunctional nanosonosensitizer termed Zr-HMME. Through post-synthetic modifications involving PEGylation and tumor-targeting peptide (F3) linkage, a nanoplatform capable of homing on melanoma was produced, which could elicit robust immune responses to suppress tumor lung metastasis in the host organism. Importantly, after seamless incorporation of positron-emitting 89Zr into this nanosonosensitizer, positron emission tomography (PET) could be used to monitor its in vivo pharmacokinetics. PET imaging studies revealed that this nanoplatform exhibited potent tumor accumulation and strong in vivo stability. Using intrinsic fluorescence from HMME, a dual-modal diagnostic capability (fluorescence and PET) was confirmed for this nanosonosensitizer. In addition, the mechanisms of how this nanoplatform interacted with immune system were also investigated. The collective data proved that the coordination structure between small-molecule drug cargos and metals may enhance the functions of each other while mitigating their weaknesses. This straightforward approach can expand the potential applications of suitable drug molecules.

Performance of the silica adsorbent from snake fruit peel for removing heavy metals of Ag, Cu, Mn, and Cr in SCW

Silver crafts wastewater (SCW) typically contains environmentally harmful heavy metals, including Ag, Cu, Mn, and Cr, necessitating treatment before disposal. This study explores a promising solution using silica (SiO2) adsorbents derived from snake fruit peel through acidic activation with HCl concentrations of 2, 4, and 6 M. Qualitative analysis of the adsorbent involved Fourier-transform infrared spectrometer (FTIR) and x-ray fluorescence (XRF) techniques. XRF analysis revealed major compositions of Si (26%) and Cl (71.46%), with minor elements such as Ca (0.91%), P (0.42%), K (0.37%), Fe (0.12%), and others. FTIR analysis indicated the presence of siloxane (Si-O-Si) and silanol (Si-OH) on the adsorbent. The SiO2 adsorbent demonstrated effectiveness in removing heavy metals (Ag, Cu, Mn, and Cr) from SCW, achieving removal percentages of approximately 16.96%, 24.38%, 19.34%, and 9.82%, respectively. This research contributes to the development of an environmentally friendly approach for SCW treatment using silica adsorbents derived from agricultural waste.

Synergistic adsorption and photocatalytic degradation of tetracycline using a Z-scheme kaolin/g-C3N4/MoO3 nanocomposite: A sustainable approach for water treatment

This research focuses on the synthesis and application of a novel kaolin-supported g-C3N4/MoO3 nanocomposite for the degradation of tetracycline, an important antibiotic contaminant in water systems. The nanocomposite was prepared through a facile and environmentally friendly approach, leveraging the adsorption and photocatalytic properties of kaolin, g-C3N4 and MoO3 nanoparticles, respectively. Comprehensive characterization of the nanocomposite was conducted using techniques such as X-ray diffraction (XRD), scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FTIR) and optical spectra. The surface parameters were studied using N2 adsorption-desorption isotherm. The elemental composition was studied using X-ray photoelectron spectroscopy. The efficiency of the developed nanocomposite in tetracycline degradation was evaluated and the results revealed an efficient tetracycline degradation exhibiting the synergistic effects of adsorption and photocatalytic degradation in the removal process. The tetracycline degradation was achieved in 60 min. Kinetic studies and thermodynamic analyses provided insights into the degradation mechanism, suggesting potential applications for the nanocomposite in wastewater treatment. Additionally, the recyclability and stability of the nanocomposite were investigated, demonstrating its potential for sustainable and long-term application in water treatment.

Evaluation of Flavonoid-rich Fraction of Portulaca Grandiflora Aerial Part Extract in Atherogenic Diet-induced Atherosclerosis.

Portulaca grandiflora is a tiny, upright herb that contains a variety of chemical components, including alkaloids, glycosides, mucilage, proteins, tannins, flavonoids, saponins, polysaccharides, and triterpenoids possessing properties that may help with atherosclerosis. The reported pharmacological properties of Portulaca grandiflora are antioxidant, antidiabetic, antiasthmatic, antibacterial, antiulcer and anti-inflammatory properties. The yield of methanol extract is higher than that of ethanol and acetone, and its phytoconstituents, like flavonoids and polyphenols, and has potent antioxidant properties. In order to determine the effectiveness ofPortulaca grandiflora methanol extract fraction against high-fat diet (HFD)-induced hyperlipidemia, hemodynamic change, antioxidant levels, and vascular dysfunction in rats, a study was carried out on a flavonoid-rich methanol extract fraction of the aerial part of Portulaca grandiflora Hook. This method involves a study of 30 days involving male Wistar rats (240-250 g) (n=5) that were fed with an Ath diet. Study groups were divided into (i) The Control Group, (ii) the Diseases Control Group, (iii) Disease + Standard drug (Atorvastatin 20mg/kg, orally, (iv) Disease + Test Extract dose 1 (Portulaca grandiflora 200mg/kg orally), and (v) Disease + Test Extract dose 2 (Portulaca grandiflora 400mg/kg orally). Both the test drug Portulaca grandiflora and the standard drug Atorvastatin were given orally for 30 days. At the end of the study, blood samples were taken to measure the serum lipid profile, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, and levels of oxidative tissue stress. Hemodynamic parameters and aortic staining were performed. Portulaca grandiflora treatment improved the lipid profile and considerably reduced oxidative stress levels. Aortic staining examination revealed a marked reduction in atherosclerotic lesions. These results revealed that Portulaca grandiflora is an effective treatment approach in preventing atherosclerotic lesion progression, which is attributed to its protection against oxidative stress and various enzymatic activities in the Atherogenic model.

Non-Small Cell Lung Cancer Metastatic Without Oncogenic Alterations.

This overview provides a thorough review of current treatment approaches for first-line management of nononcogenic addicted non-small cell lung cancer. We also address pertinent clinical decision-making queries encountered in everyday practice, such as the optimal treatment strategy for PD-L1-high patients, predictive factors for response to immune checkpoint inhibitors (ICI) both in terms of patient and cancer characteristics, the potential benefits of dual checkpoint blockade, and the unresolved issue of safe discontinuation strategies for long-term responders. Around one in five patients falls into this latter category while the majority develop either primary or acquired resistance to ICI-based first-line therapy, necessitating effective subsequent lines of treatment. Docetaxel, with or without combination of antiangiogenic agents, serves as the backbone of treatment, although evidence in the post-ICI setting is limited. Given that an inflamed tumor microenvironment (TME) is crucial for ICI responses, targeting the TME in cases of acquired resistance alongside continued ICI administration appears rational, although clinical trials so far have failed to confirm this hypothesis. Antibody-drug conjugates have emerged as a promising treatment modality, offering the potential for reduced toxicity and improved efficacy by targeting specific cancer antigens. Moreover, several chemotherapy-free approaches are currently under investigation for treatment-naïve patients, including alternative ICI and drugs targeting epitopes on both cancer and immune cells.

Hypoxia A Typical Target in Human Lung Cancer Therapy.

Lung cancer (LC) is the leading cause of cancer-related death globally. Comprehensive knowledge of the cellular and molecular etiology of LC is perilous for the development of active treatment approaches. Hypoxia in cancer is linked with malignancy, and its phenotype is implicated in the hypoxic reaction, which is being studied as a prospective cancer treatment target. The hypervascularization of the tumor is the main feature of human LC, and hypoxia is a major stimulator of neo-angiogenesis. It was seen that low oxygen levels in human LC are a critical aspect of this lethal illness. However, as there is a considerable body of literature espousing the presumed functional relevance of hypoxia in LC, the direct measurement of oxygen concentration in Human LC is yet to be determined. This narrative review aims to show the importance and as a future target for novel research studies that can lead to the perception of LC therapy in hypoxic malignancies.

Review on therapeutic approach of anti-acne treatment by Azadirachta indica and Ocimum gratissimum

Review on therapeutic approach of anti-acne treatment by Azadirachta indica and Ocimum gratissimum

Early postoperative complications in open heart surgery patients: A review

Over the past few decades, open heart surgery has undergone significant progress in terms of technologies used, operative techniques and resuscitation care. This has led to a significant increase in patient survival and quality of life after discharge. However, there are still a number of challenges to be addressed, one of which is reducing the incidence of early postoperative complications. They are directly and primarily determined by patients’ demographic and clinical characteristics, as well as by the characteristics of the surgical intervention itself and are a major factor in the outcome of the surgery performed. This review presents the most important and frequent early complications, their epidemiological and clinical features. Their good knowledge is the key to achieving an optimal treatment approach and seeking effective opportunities for their prediction and incidence reduction.

MBE-CASSCF Approach for the Accurate Treatment of Large Active Spaces.

We present a novel implementation of the complete active space self-consistent field (CASSCF) method that makes use of the many-body expanded full configuration interaction (MBE-FCI) method to incrementally approximate electronic structures within large active spaces. On the basis of a hybrid first-order algorithm employing both Super-CI and quasi-Newton strategies for the optimization of molecular orbitals, we demonstrate both computational efficacy and high accuracy of the resulting MBE-CASSCF method. We assess the performance of our implementation on a set of established numerical tests before applying MBE-CASSCF in the investigation of the triplet-quintet spin gap of iron(II) porphyrin with active spaces as large as 50 electrons in 50 orbitals.

Effectiveness of Anti-Calcitonin Gene-Related Peptide Medication in Vestibular Migraine: A Retrospective Cohort Study in an Asian Population.

Migraine and dizziness often coexist, with vestibular migraine (VM) presenting with vestibular symptoms and headaches. Calcitonin gene-related peptide (CGRP) may be involved in motion-induced symptoms; however, studies on the use of anti-CGRP monoclonal antibodies (mAbs) for the treatment of VM have yielded conflicting results. This study aimed to clarify the effectiveness of anti-CGRP mAbs in VM treatment. This retrospective observational cohort study, conducted between 1 January 2021 and 31 March 2023, assessed 12 Japanese patients with VM who were treated with anti-CGRP mAbs (CGRP group) for 6 months and 11 Japanese patients who received standard of care for VM and served as controls. Clinical questionnaires and equilibrium tests were administered, with primary outcomes including changes in Dizziness Handicap Inventory (DHI) scores compared with baseline values. Objective variables included the DHI score and explanatory variables included demographic data, balance test results, head-up tilt (HUT) test results, vestibular test results and questionnaire survey results. Analysis of variance was used to assess the treatment effects of anti-CGRP mAbs, and multivariate regression analysis was performed to identify mAb responders. After 6 months, the CGRP group showed significant improvements in DHI scores [0 versus 6 months, odds ratio (95% confidence interval): 22.01 (0.13-43.88)] and number of vertigo/dizziness attacks per month [0 versus 6 months: 10.28 (2.80-17.76)]. No significant difference was observed in the control group [DHI scores, 0 versus 6 months: 0.65 (-26.84 to 28.14); number of vertigo/dizziness attacks per month, 0 versus 6 months: - 8.07 (- 23.77 to 7.62)]. Multivariate regression analysis showed that autonomic function at baseline was associated with mAb response in patients [β estimates (95% confidence interval): 3.63 (0.21-7.06)]. Treatment with anti-CGRP mAbs was more effective than conventional treatment in preventing migraine in patients with VM. While the identified factors associated with treatment responsiveness offer valuable insights into personalised treatment approaches, further prospective studies are warranted to validate the findings due to our study's retrospective design and limited sample size.

Mental Health Treatment Utilization and Unmet Mental Health Needs Among Black Reproductive-Age Women in the United States.

Black women in the United States experience increased risk for mental disorders and are less likely to have access to appropriate mental health treatment compared with White women. To develop culturally responsive strategies to improve Black women's access to mental health treatment, the authors evaluated social determinants associated with mental health treatment utilization and unmet mental health needs among Black reproductive-age women with serious psychological distress. The authors performed a secondary analysis of data from the National Survey on Drug Use and Health. Data from 2009 to 2019 were pooled and restricted to Black women ages 18-44 years with serious psychological distress (N=4,171). Logistic regressions were conducted to identify personal and social determinants (e.g., education, employment status, poverty, and insurance status) of mental health treatment utilization, alternative mental health treatment utilization (e.g., spiritual support and self-help), and perceived unmet mental health needs. Education and employment status were significantly associated with all three outcomes. Among the women who reported unmet mental health needs, opposition to treatment and cost were the highest endorsed barriers. Differences were found by pregnancy status, with pregnant women being significantly less likely to endorse cost (p<0.001) and more likely to endorse time and transportation as barriers (p<0.01) to receiving mental health treatment. Strategies to improve mental health outcomes for Black women should focus on reducing cost and transportation barriers and on the development of culturally responsive intervention approaches that address Black women's concerns about mental health treatment.

Systematic Review Overview: Violence Against Adults with Disabilities.

This study aimed to conduct an overview of systematic reviews in the field of violence against adults with disability. Eight electronic databases as well as gray literature from January 2022 to April 2023 were searched to identify systematic reviews that focused on violence against adults with disabilities. A total of 13 high-quality systematic reviews were included in the overview. Findings show that adults with disabilities experience a higher rate of emotional and physical violence than the general population. Sociodemographic, financial, and cultural risk factors, prevention, and treatment approaches were discussed. Although the large body of studies on disability and violence have explored different aspects of the issue, there are some limitations and gaps in the literature that need further attention. The most important gap in the literature is the lack of attention to diversity. Accordingly, there is little knowledge about disability and violence in a variety of geographical locations. In addition, studies on violence based on ethnicity/race, age, gender identifications, and some types of disabilities such as hearing impairments or severe disabilities were scarce. There is a need to reach diverse populations of adults with disabilities, through employing a variety of data collection methods and qualitative research methodology. Prevention and treatment programs should be developed with attention to types of disability, and they should be culturally and linguistically sensitive.

Hypomineralised second primary molars: the Würzburg concept.

In addition to molar incisor hypomineralisation, the occurrence of enamel hypomineralisation in the primary dentition has become increasingly important in recent years. Hypomineralised second primary molar (HSPM) is defined as hypomineralisation of systemic origin affecting from one to all four second primary molars. Some years ago, the "Würzburg concept" was introduced, which proposed a grading of MIH findings (MIH treatment need index) in combination with an appropriate treatment plan depending on the severity of the affected tooth. Recently, this concept was updated and new treatment approaches have been added. However, currently, the concept solely addresses the treatment plan for permanent teeth. As there is a need to expand its scope to encompass primary teeth and, consequently, HSPM, this paper seeks to develop the second component of the Würzburg concept, the treatment plan, for the primary dentition in response to the increased focus on the disease in recent years. Although the evidence base for the different treatment options is still weak, there is a need for guidance for clinicians in their day-to-day practice. The authors conducted a comprehensive review of the literature, encompassing clinical and laboratory studies along with published guidelines. The treatment plan of the HSPM Würzburg concept contains prophylactic and regenerative aspects, non-invasive interventions, temporary and permanent restorative techniques, and extraction. The intention is to provide practical guidance to practitioners, acknowledging the necessity for further validation through clinical trials.

Percutaneous Endovascular Reconstruction of the Common Femoral Artery and Its Bifurcation

Occlusive lesions of the common femoral artery (CFA) and its bifurcation have traditionally been treated with open surgery. Although long-term patency rates after open surgery are excellent, such repairs are associated with substantial local and general morbidity. In recent years, different treatment options have emerged within percutaneous endovascular repair. We hereby present a narrative review on endovascular treatment modalities and a treatment algorithm for endovascular revascularisation of the CFA and its bifurcation. Lesion analysis, access issues, vessel preparation tools, and types of repairs with or without the involvement of the bifurcation are described. Based on current data, an interventional approach can result in high technical success and acceptable mid-term patency rates. Further comparative evidence with open surgery and/or between the different types of endovascular repairs is required to improve the current treatment algorithm.

Advancements and challenges in triple-negative breast cancer: a comprehensive review of therapeutic and diagnostic strategies

Triple-negative breast cancer (TNBC) poses significant challenges in oncology due to its aggressive nature, limited treatment options, and poorer prognosis compared to other breast cancer subtypes. This comprehensive review examines the therapeutic and diagnostic landscape of TNBC, highlighting current strategies, emerging therapies, and future directions. Targeted therapies, including PARP inhibitors, immune checkpoint inhibitors, and EGFR inhibitors, hold promise for personalized treatment approaches. Challenges in identifying novel targets, exploring combination therapies, and developing predictive biomarkers must be addressed to optimize targeted therapy in TNBC. Immunotherapy represents a transformative approach in TNBC treatment, yet challenges in biomarker identification, combination strategies, and overcoming resistance persist. Precision medicine approaches offer opportunities for tailored treatment based on tumor biology, but integration of multi-omics data and clinical implementation present challenges requiring innovative solutions. Despite these challenges, ongoing research efforts and collaborative initiatives offer hope for improving outcomes and advancing treatment strategies in TNBC. By addressing the complexities of TNBC biology and developing effective therapeutic approaches, personalized treatments can be realized, ultimately enhancing the lives of TNBC patients. Continued research, clinical trials, and interdisciplinary collaborations are essential for realizing this vision and making meaningful progress in TNBC management.

MR diffusion-weighted imaging precision in BIRADS downstaging

BackgroundBreast cancer is a major cause of both morbidity and mortality. Therefore, it is essential to promptly identify breast cancer in order to implement a more cautious surgical approach for disease treatment. Breast ultrasonography examination has long been used as a supplementary technique to mammography to evaluate palpable or mammographically detectable breast masses. Presently, Breast MRI has become an essential instrument for the detection and analysis of breast cancer. Diffusion-weighted imaging (DWI) is MRI technique that quantifies the movement of water molecules within tissue. It can provide valuable information about the density, viscosity, integrity of membranes, and microstructure of tissues. This study included sixty patients with Equivocal/high BIRADS lesions, underwent Mammography and /or U/S, CEMRI with DWI.Aim of the workThe aim of this study was to disclose MRDWI potency in depiction and assessment of different breast lesions unaccompanied by contrast-enhanced MRI with a view to avoid the high cost of the MRI contrast, lessen the number of needless biopsies and probably reclassify breast lesions of high BIRADS categories.ResultsThis prospective study included 58 patients (with 60 breast lesions), who came with sono-mammography breast lesions of BIRADS lesions > 2, comparison between sono-mammographic BIRADS and MRI BIRADS was done, where 40 cases were downgraded by MRBIRADS. On paralleling MRDWI unescorted by contrast-enhanced MRI with sono-mammographic BIRADS, 36 cases were downgraded. Correlation between pathology of the biopsied lesions with sono-mammography, MR BIRADS and MRDWI was done as well. Sono–mammography shows 88.9% sensitivity and 61.9% specificity with accuracy of 77.7%. Combined CE –MRI and DWI shows 94% sensitivity and 97.6% specificity with accuracy of 96%. While DWI solely shows 88.9% sensitivity and 90.5% specificity with accuracy of 96%. The cutoff value of ADC for prediction of malignancy was 0.9 with 94% sensitivity, 87% specificity and 83.3 accuracy.ConclusionsCEMRI is un-debatably effective in depicting and discriminating indeterminate breast lesions chiefly when combined with DWI. Yet, with the high expense of the contrast and in the event of contrast contraindications or unavailability, DWI has proven to be a convenient substitute for CE-MRI aiding in rendering the breast lesion BIRADS downgraded with diminishing the unneeded biopsies.