Open Access Case Report

Malignant Osteopetrosis, a Rare Cause of Bicytopenia in Infants: A Case Report

Karima Larbi Ouassou, Abdelilah Radi, Amal Hassani, Rachid Abilkassem, Aomar Agadr

Journal of Advances in Medicine and Medical Research, Page 69-76
DOI: 10.9734/jammr/2021/v33i1330956

Osteopetrosis is an autosomal metabolic bone disease caused by a functional abnormality of the osteoclasts. Two main forms exist, the dominant benign form and the recessive malignant form. We describe in our patient the recessive malignant form retained according to all the clinical, biological and especially radiological criteria. We also report in this work the elements of description of the disease in the literature in comparison with the data of our patient, which allows us to emphasize the severity of the ocular and bone damage requiring an early marrow transplant which alone seems to cure the disease.

Open Access Study Protocol

Relationship between Toxoplasma Gondii and Psychotic Disorders with Implications toward a Brain-based Diagnostic System and Novel Treatment Approaches: A Study Protocol

Dina Raja, Shyamanta Das, Chimanjita Phukan, Simanta Talukdar, Samrat Singh Bhandari, Naba Kumar Hazarika, Dipesh Bhagabati

Journal of Advances in Medicine and Medical Research, Page 82-88
DOI: 10.9734/jammr/2021/v33i1330958

What role infectious agents play in the causation of psychotic disorders? To investigate this area, we have aimed to investigate the relationship between Toxoplasma gondii and psychotic disorders. A hospital-based cross-sectional study is designed. IgM and IgG antibodies to T. gondii in patients with psychotic disorders will be measured and presented in result. Seropositivity rates will be compared with first-degree relatives and healthy volunteers. Also, types of psychotic disorders and seropositivity rate will be compared. Here, we are presenting the study protocol with implications toward a brain-based diagnostic system and novel treatment approaches.

Open Access Opinion Article

Role of Mothers’ Awareness of HIV Status in Prevention of Mother-to-Child Transmission

Jiman He

Journal of Advances in Medicine and Medical Research, Page 77-81
DOI: 10.9734/jammr/2021/v33i1330957

Current guidelines on HIV prevention conflict over whether oral exposure to HIV positive blood is a risk for transmission. This issue is especially important for young children, because, 30–80% of people infected with HIV have at least one oral manifestation, with the most frequently occurring ones often bleeding, and children born to HIV infected mothers are often exposed to the blood through multiple ways (e.g. kissing and sharing spoon, cups, or food, etc.). For the present paper, I examined data collected in sub-Saharan Africa from 2000 to 2020 which showed that, the decline in annual new HIV infections in young children was closely correlated with an increase in the proportion of women aware of their HIV status. This finding suggests that, mothers’ behavioral change (e.g. avoiding kissing and sharing spoon, cups, or food, etc.) due to awareness of their HIV status played an important role in prevention of mother-to-child transmission, and testing for HIV should be pursued for all pregnant women in high prevalence areas.

Open Access Original Research Article

Inflammatory and Immune Biomarkers in Predicting the Severity in COVID-19

Shrishti Dhar Prasad, Suprava Patel, Ajoy Kumar Behera, Dibakar Sahu, Seema Shah, Rachita Nanda, Eli Mohapatra

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/jammr/2021/v33i1330950

Aims: An early diagnosis of severity can be confidently judged by monitoring the serum biomarkers in patients with COVID-19. The study was thus aimed to explore the relationship of the inflammatory and immune biomarkers in predicting the severity of the disease.

Study design: It is a retrospective observational study.

Methodology: The study included 79 confirmed cases of COVID-19 who had complete clinical record for the analytical variables. All cases were assigned a total clinical score as per their clinical manifestations, associated co-morbidities and mortality outcome. Laboratory inflammatory and immune biomarkers at the time of admission were noted.

Results: The mean age of the study population was 55.38 (1.69) years. The percentage of admission for males (67.1%) was twice that of females (32.9%). Serum LDH (p=0.003) and ferritin (0.019) levels were remarkably raised in severe form. Total clinical score denoted a positive correlation with the inflammatory biomarkers (p<0.001). IgM exhibited a significant negative trend with increasing clinical score (p<0.001) and CRP levels (p=0.022) of the patients. The multivariate analysis reflected that the total clinical score was significantly influenced by initial SpO2 values (0.011), serum ferritin (0.027), IgM (0.001) and C3 levels (0.044) in the COVID-19 patients. Lower serum C3 values significantly influenced the hospitalization duration in moderate cases (p=0.034) and total clinical score in severe cases (p=0.01).

Conclusion: The findings of the study signified that besides serum ferritin, a serial and close monitoring of serum IgM with complement factor C3 would aid in early prediction of clinical severity and thus guide physicians to start effective management strategy.

Open Access Original Research Article

Extent of Home Based Care Program Support to Hospital Based Care for Children with Chronic and Terminal Illness in Meru County, Kenya

P. K. Kubai, M. R. Kei, A. M. Mutema

Journal of Advances in Medicine and Medical Research, Page 14-26
DOI: 10.9734/jammr/2021/v33i1330951

Introduction: Chronic and Terminal illnesses continue to increase and aggravate the burden of disease and the diminish space in our hospitals and communities, Worldwide, 57 million persons died in 2008, an estimated 40 million were in need of HBCP, 6.6 - 10.8 million Children died, 98% Chronic and Terminal illnesses (CI/TI) are found in low and middle-income Countries. Chronic and Terminal illnesses in Children are on the rise in Sub Saharan Africa. Kenya lags in implementation of Home Based Care to mitigate effects of CI/TI. WHO, 2017 and Ministry of Health-Kenya 2013 shows that Children are affected by these Illnesses. These illnesses have made families’ to suffer psychosocial and economic hardships. Evaluation of determinants of Home Based Care Program (EHBCP) services by assessing if effective and quality delivery of HBCP Supports Hospital Based Care is key.

Aims: To determine the extent to which Home Based Care Program services Support to Hospital Based Care for Children aged 1-14 years diagnosed with selected Chronic and Terminal illnesses in Meru County Kenya.

Study Design: A descriptive Cross Sectional Survey.

Place and Duration of Study: Meru County, Kenya between June 2018 and Dec 2019.

Methodology: Methodology: Descriptive Cross Sectional Survey of 245 Caregivers of Children diagnosed with Chronic and Terminal illness were selected by proportionate to size sampling and simple random sampling from Meru County Health Facilities.

Results: Delivery of quality and effective Home Based Care Program was positively associated with age, return rate of over 100% was achieved with about 245 respondents being interviewed (132%),experience of Health Care Workers (HCWs) 4.8 [95% CI = 1.06 – 21.68, P = 0.041]. HCWs profession, gender and years of work were positively related to Hospital Based Care services 3.03 [95%CI = 1.64 – 5.59, P<0.001]. Use of minimum HBCP package was found to be useful in support of hospital care, as 50.4% reported that its support was of a good or great extent. The trend was observed in all aspects of the minimum HBCP package studied, with 52.4%, 54.4% and 46.4% having the opinion that use of the package by caregivers, in management and mitigation of complications supported hospital care by a good or great extent respectively.

Conclusion: Need for an urgent adoption of holistic approach on health care system strengthening by putting up a well-integrated Home Based Care Program with quality Minimum HBCP essential package to support the mainstream health care system. In addition adopt better management practices, planning strategies, resource allocation and monitoring for effective HBCP programmes as per the current guidelines to bridge the gaps identified in planning, management practices to fill the disjointed policy implementation and resource inadequacies in implementation of HBCP services to support Hospital Based care for ultimate delivery of quality care among the Chronically and Terminally ill Children.

Open Access Original Research Article

A Simple Risk Scoring System for Predicting Recurrence in Women with Locally Advanced Breast Cancer (LABC) Treated with Neoadjuvant Chemotherapy (NACT)

Sushma Agrawal, Prabhakar Mishra, Anjali Mishra, Gaurav Agarwal

Journal of Advances in Medicine and Medical Research, Page 27-37
DOI: 10.9734/jammr/2021/v33i1330952

Introduction: Breast cancer commonly presents in locally advanced stage (LABC) in developing countries, for which NACT followed by surgery and radiotherapy is the standard of care. There is a need for a simple tool to risk categorise patients in the clinic, so that treatment intensification can be offered to women with high risk of recurrence.

Materials and Methods: Data of prospectively maintained database of LABC (between January 2007 - December 2012), who received NACT followed by surgery, radiotherapy and endocrine therapy was retrospectively analysed for clinico-pathological factors associated with disease recurrences. A recurrence risk scoring model was developed on the basis of regression coefficient of identified independent risk factors.

Results: In the data set of 206 patients, the median follow-up was 48 months (range: 6-156 months) and mean and median disease-free survival (DFS) were 87.41 and 85 months. The 1, 5, 10 years DFS was 95%, 54% and 41%. The independent risk factors (on modified p value <0.40) for recurrence were Tumour stage, Nodes stage, grade, age groups, pathologic complete response, intrinsic subtype, and type of surgery. Risk score prepared by regression coefficient (β), was in the range of 1-8 with median score of 5. ROC curve showed that area under ROC Curve of the score was 71.8% (95% CI: 64.8%-78.8%, p<0.001). To detect recurrences, a risk score ≥3 had at least 93.1% sensitivity and 31.9% specificity whereas score ≥4 had at least 73.5% sensitivity and 59.6% specificity. Based on cluster analysis, score 1-4 was identified as low risk whereas 5-6 as moderate risk group and ≥7 identified as high-risk group and their mean/median disease free survival time were 107.86/ NR, 66.99/30 months and 58.34/20 months respectively.

Conclusions: The significant difference in DFS among three risk groups, indicates goodness of the fit of our risk score model. The risk scoring model developed by us is simple, easy to use in clinic and can be used for selecting high risk patients who benefit from treatment intensification.

Open Access Original Research Article

Carotid Intima Media Thickness and Endothelial Function: Useful Surrogate Markers for Cardiovascular Risk in Rheumatoid Arthritis Patients

Riham A. El-Sehly, Abeer A. Shahba, Raghda G. Elsheik, Mahmoud F. Selim

Journal of Advances in Medicine and Medical Research, Page 38-48
DOI: 10.9734/jammr/2021/v33i1330953

Introduction: Cardiovascular diseases (CVDs) are the main cause of morbidity and mortality in RA disease. In active RA patients, the majority of cardiovascular deaths result from accelerates atherosclerosis.

Aim of the Work: The aim of this work is to assess carotid intima media thickness (C-IMT) and endothelial function by brachial artery flow mediated dilatation (FMD) in Rheumatoid arthritis patients and relation to the disease activity.

Subjects and Methods: Our study included 50 RA patients, from Tanta University Hospital. 47 women and 3 men and their age ranged from 30-62 years.  They were divided into group 1:  25 active RA patients, group 2:  25 inactive RA patients who were   diagnosed by American College of Rheumatology (ACR) revised criteria for diagnosis of RA 1987 and disease activity was evaluated using disease activity score 28(DAS28). Group 3: 25 normal subjects as a control group.  We measured C-IMT and FMD in all groups.

Results: By comparing the groups, we found that active RA patients had increased C-IMT compared to inactive rheumatoid arthritis patients and controls which is indicator of atherosclerosis. FMD of the brachial artery impaired in RA patients compared to controls which is indicator of endothelial dysfunction. There was highly statistically significant relation between duration, activity of RA disease and atherosclerosis in RA patients.

Conclusion: With increasing the frequency of atherosclerosis in asymptomatic RA patients, carotid IMT increased and FMD impaired when compared with general population. Active RA patients have increased carotid IMT and impaired FMD compared with inactive RA patients.

Open Access Original Research Article

Rheumatoid Factor and Anti-Cyclic Citrullinated Peptide Antibodies Levels in Chronic Viral Hepatitis (B&C)

Ghada Mohamed Ramadan, Medhat Abd-Elmegied Ghazy, Maaly Mohamed Mabrouk, Mohamed Hassan El-Naggar

Journal of Advances in Medicine and Medical Research, Page 49-57
DOI: 10.9734/jammr/2021/v33i1330954

Background: Extrahepatic manifestations is a relatively common feature in patients with chronic hepatitis C virus infection. Among the different clinical disorders associated with HCV infection, articular involvement is a frequent complication, and the clinical picture of HCV related arthropathy varies widely. In particular, monoarticular or oligoarticular involvement affects larger joints and is typically associated with mixed cryoglobulinemia, whereas symmetric polyarthritis associated with HCV infection frequently displays a rheumatoid arthritis like clinical picture which can be clinically indistinguishable from RA itself. This study aimed to evaluate level of Rheumatoid Factor and anti-CCP level in chronic viral hepatitis B&C.

Patients and methods: Thirty patients with rheumatoid arthritis, thirty patients with                     chronic hepatitis C virus and thirty patients with chronic hepatitis B virus were selected to perform this study and they were compared to thirty normal subjects as a reference                                      group.

Results: There was significant difference between the hemoglobin in the four groups. As regard Rheumatoid Factor there was significant difference between the studied groups. As regard Anti-CCP, there was significant difference between the studied groups. There was also significant difference between the four groups according to level of positivity. Finally, our study shows clinically significant positive correlation between RF as well as anti CCP titer and both HBV DNA and HCV RNA viral levels.

Conclusions: Rheumatoid factor was found with considerable percentage in chronic HBV & HCV patients without musculoskeletal manifestations. Anti-CCP can be detected with low positivity in chronic HBV&HCV patients even without arthritic manifestations. There is a significant positive correlation between RF titre and HBV DNA& HCV RNA in chronic hepatitis patients. There is a significant positive correlation between anti-CCP and HBV DNA& HCV RNA in chronic hepatitis patients. Chronic HBV & HCV can be considered and investigated in patients with positive RF and/or anti CCP without arthritic manifestations.

Open Access Original Research Article

Comparative Study between Ivabradine Versus Bisoprolol Effects for Heart Rate Control on Hemodynamics and Clinical Outcomes in Patients with Septic Shock

Omnia Ali El-Miseery, Hesham Elsaid Elashry, Magdy Elsaid Elbably, Magdy Elsaid Elbably, Ahmed Mohammed Hamed

Journal of Advances in Medicine and Medical Research, Page 58-68
DOI: 10.9734/jammr/2021/v33i1330955

Background: Septic shock is associated with excessive sympathetic outflow, high plasma catecholamine levels, myocardial depression, vascular hypo-reactivity, and autonomic dysfunction. Typically, patients have a low resistance, high cardiac output circulation with tachycardia and arterial hypotension that may be poorly or even nonresponsive to exogenous catecholamine vasopressors. The aim of the present study was to compare the effect of ivabradine vs bisoprolol for heart rate control on the hemodynamics and clinical outcomes in patients with septic shock.

Methods: The study was carried out on 90 patients, aging from 18 to 60 years of both sex presented with septic shock in ICU. Patients were randomly classified into 3 equal groups each of 30 patients. Group I (Control group) received conventional therapy. Group II (Bisoprolol group) received conventional therapy plus bisoprolol 5 mg once daily & one placebo pill on 12 hrs interval via nasogastric tube for 7 days. Group III (Ivabradine group) received conventional therapy plus ivabradine 5 mg twice daily on 12 hrs interval via nasogastric tube for 7 days.

Results: Both bisoprolol and ivabradine effectively lowered heart rate in septic shock patients but ivabradine was more effective than bisoprolol. Both bisoprolol and ivabradine did not affect mean blood pressure, with ivabradine being more effective in maintaining blood pressure than bisoprolol. Noradrenaline dose was lower in ivabradine group in comparison with the other two groups. As regard to stroke volume & cardiac output, there was improvement in ivabradine group in comparison with bisoprolol and control groups. As regard to serum lactate level, there was improvement in ivabradine group in comparison with the other two groups. Both bisoprolol & ivabradine resulted in reduction in LOS & 28-day mortality with no significant difference between both groups.

Conclusions: Controlling heart rate in septic shock patients with either bisoprolol or ivabradine improves outcomes. Ivabradine is better than bisoprolol in maintaining hemodynamics and improving tissue perfusion parameters.

Open Access Original Research Article

An Autopsy Study of the Quantitative Anatomy of Human Heart

S. Raveendran, M. Vidanapathirana, S. R. Hulathduwa

Journal of Advances in Medicine and Medical Research, Page 89-99
DOI: 10.9734/jammr/2021/v33i1330959

There is no uniformity in obtaining anthropological measurements of the heart. Measurementsvary according to the methods used by different authors. The normality standard for organ weights should be established in a specific reference sample for each population, as the normality values can be different under genetic and environmental influences. This study is aimed to determine the average values of quantitative anatomy of the adult heart for the Sri Lanka population using autopsy data with an attempt to determine the relationship with sociodemographic factors such as the body weight, age, gender and the body length. Designed as a descriptive cross-sectional prospective study, it was performed on fresh (unfixed) adult hearts recovered at medico-legal autopsy on deaths due to non-cardiac natural causes and miscellaneous unnatural causes for a period of one year. Systematic consecutive sampling method was used from September 2018 to September 2019. Only 122 samples (68 males and 54 females) were included from among 282 adult hearts collected during this period due to strict inclusion and exclusion criteria. Average weight of the heart, thicknesses of the inter-ventricular septum, free wall of the left ventricle and right ventricle for males and females were 296.1 g, 236.85 g, 9.71 mm, 9.52 mm, 1.28 cm, 1.19 cm and 3.41mm, 3.02mm respectively. Male heart weight, interventricular septal thickness and other findings were compatible with contemporary Eastern studies. Significant association was demonstrated in the wall thickness of right ventricle with gender (P- value being 0.038).  Large scales multi centered studies to find out the normality standard for heart measurements in Sri Lankan population are recommended.

Open Access Original Research Article

Prevalence of Depression and Its Associated Factors among Diabetes Mellitus Patients in an Urban Primary Care Clinic

M. Miskan, K. Ambigga

Journal of Advances in Medicine and Medical Research, Page 100-106
DOI: 10.9734/jammr/2021/v33i1330960

Aims: To determine the prevalence of depression among patients with Diabetes Mellitus and to identify its associated risk factors.

Study design:  This is a cross sectional study.

Place of study: This study was conducted in an urban primary care clinic in a tertiary hospital in Malaysia.

Methodology: This study utilized a self-administered questionnaire, Hospital Anxiety and Depression scale (HADS-D) for the data collection. A total of 358 respondents were eligible to be included in this study.

Results:  A total of 382 respondents were recruited in this study using universal sampling method. A total number of 358 eligible respondents were included in the final data analysis. The response rate for this study was 94%. Respondents’ mean age was 60.8 years ± 10.3, 56% females, 38% Malays, 76% were married, 37.7% had Diabetes for more than 5 years and 76.3% had completed secondary school education. This study concluded that 63.7% of participants had poor diabetes control and 26% had probable depression. On multiple logistic regression, respondents who earned income less than RM 500 per month were 2.6 times more likely to have probable depression (aOR: 2.64, 95% CI:1.29 -5.43). Patients who received no formal education were 4.5 times more likely to have probable depression (aOR: 4.51 95% CI:1.74-11.63). Respondents with co-morbid illness were almost 3 times more likely to have probable depression (aOR: 2.92, 95% CI: 0.1-0.8).

Conclusion: Prevalence of probable depression was high and there was a significant association between depression with income, education level and co-morbid illness. Thus, there is a need to identify and manage depression accordingly among diabetic patients.

Open Access Original Research Article

Mesenteric Venous Thrombosis in a Referral Hospital in East Africa: A Retrospective Study of Four Cases

Richard Wismayer

Journal of Advances in Medicine and Medical Research, Page 107-116
DOI: 10.9734/jammr/2021/v33i1330961

Introduction: Acute mesenteric venous thrombosis is a rare condition with the most common site of thrombosis development being the superior mesenteric vein. Patients predisposed to this condition tend to develop a disruption to Virchow’s triad of endothelial injury, stasis and hypercoagulability. In the acute form the presentation is with bowel ischaemia and so a diagnosis before bowel gangrene develops remains a challenge. The limited experience with this condition in the East African region shows that a delayed diagnosis due to limited investigative capacity results in patients’ experiencing acute renal failure and a high mortality. This review describes the aetiology, clinical features and management of acute mesenteric venous ischaemia.

Methods: A descriptive retrospective review of four patients over an 18-month period. Demographic and clinical data was extracted from the patients’ clinical files and manual analysis using a spreadsheet was performed.

Results: Over an 18-month period, four patients were reported. All patients had a delay in diagnosis with acute symptoms persisting for 5 days up to 21 days. Two patients died within 30-days post-operatively of complications which included short bowel syndrome and acute kidney failure. Two patients survived developing complications from short bowel syndrome and another the complications of acute kidney injury requiring haemodialysis.

Conclusions: A delay in diagnosis of acute MVT characterises this short case series. This resulted in all cases presenting with gangrenous bowel and hence the high mortality. Venous clot propagation is prevented with anticoagulation which is associated with decreased mortality and recurrence. Thrombolysis and thrombectomy should be considered in certain circumstances to prevent bowel of questionable viability. In the last four decades the mortality from MVT has decreased and currently stands at 10-20% however there is no sufficient literature in East Africa to make this judgement.

Open Access Original Research Article

Analysis of Method of Axillary Crutch Measurement

Augustine Amaeze Amaeze, Ngozi F. Amaeze, Emmanuel Ifeanyi Obeagu, Charles I. Ezema, Chukwudi Uchenna Onwudiwe, Clementina N. Eze, Chukwuenyegom Joseph Egbumike

Journal of Advances in Medicine and Medical Research, Page 117-123
DOI: 10.9734/jammr/2021/v33i1330962

The purpose of this study was to determine which of the 3 methods axillary measurement best predict ideal crutch length. Ideal crutch length is defined as the length of the crutch, including accessories, obtained during stance when the crutch tip is 15.2cm lateral and 15.2cm anterior to fifth toe and the axillary pad is 6.4cm below the axillary fold. Two hundred and twenty-four (224) volunteers were measured for crutches using each of the following methods: 77% of actual height; actual height minus 40.6cm and anterior axillary fold to heel in supine position with arm adducted. The result of the calculation were statistically significant (p<0.01). However, 77% of actual height and actual height minus 40.6cm had the strongest relationship to the ideal crutch length r (person Product Moment Correlation Coefficient) = 0.941; r2 (linear regression correlation coefficient) = 0.89; p<0.01. Axillary fold heel method had r =0.917: r2= 0.84; P<0.01.

Open Access Original Research Article

Knowledge Levels and Practice Regarding Breastfeeding among Mothers with Children under 2 Years Admitted in the Pediatric Ward at Mnazi Mmoja Hospital, Zanzibar

Fat-hiya Abdallah Said, Chukwuma J. Okafor, Said Ali Yusuf, Amina A. Ali, Khamis A. Abeid, Salma Abdi Mahmoud, Ufuoma Chukwuani, Ayan Ahmed Hussein, Sabahi Salum Khamis, Amina Abdi Hamid

Journal of Advances in Medicine and Medical Research, Page 124-133
DOI: 10.9734/jammr/2021/v33i1330963

Breastfeeding (BF) has been a proven means of providing young infants with the nutrients required for healthy growth and development. The process has also been known to reduce common childhood infections, which are the causes of high mortality and morbidity.  Hence in achieving the best practice of BF, both knowledge and techniques are essential. Therefore, the study aims to assess the knowledge and practice on BF among mothers whose children were admitted at Mnazi Mmoja Hospital, Zanzibar. The study was a cross-sectional descriptive hospital-based carried out in the pediatric ward of MMH from April 2020 to July 2020 after approval by the hospital's health and ethics committee. Questionnaires were deployed to interview all consenting participants who were mothers aged from 18 to 50 years, breastfeeding a child, and having at least one previous child who had been breastfed earlier (Above 2 years) at the time of the study.  Selected questions were used to assess and categorized a total of 199 mothers who were recruited into the study as those with knowledge, those without knowledge on Exclusive breastfeeding (EBF), breastfeeding (BF) for 2 years, and breastfeeding techniques (BFT). Data were analyzed using Statistical Package for Social Sciences version 16. Differences at P < 0.05 were considered significant. About 76.9% of the mothers studied had knowledge of EBF, while 65% had knowledge of BF for two years. A total of 42 (21.1%) had children below 6 months and were still BF, with the remaining 157(78.9%) having children above 6 months. Among the 157, only 58 (37%) practice EBF for 6 months. Also, 130 (65.3%) mothers breastfed their children up to 2 years in their previous child's upbringing. Most of them (42%) stopped because they became pregnant. The breastfeeding technique (BFT) was affected by the mother's age but not education level, as more of the older mothers had good positions and attachments than the younger ones. On overall techniques, 58.5% had good attachment compared to 49.7% who had proper position. Although most mothers were aware of the knowledge of EBF for 6 months, the practice is still low. However, older mothers, particularly the age group 31-40, have good BFT compared to younger mothers. There is a need for more education on EBF, BF, and BFT among women during Antenatal Clinic (ANC) and after delivery during the monthly clinic.

Open Access Original Research Article

Role of Endoscopic Ultrasound Guided Fine Needle Aspiration in the Diagnosis of Cystic Pancreatic Lesions

Ahmed Metawea Elsefy, Mohamed Ali Elnady, Mervat Abd El-Hamed Elkhateb, Hegazy Mohammed Hegazy

Journal of Advances in Medicine and Medical Research, Page 134-147
DOI: 10.9734/jammr/2021/v33i1330964

Background: The diagnosis and management of cystic lesions of the pancreas is an increasingly recognized problem in clinical practice and many of the cystic pancreatic lesions are neoplastic and asymptomatic. Despite the significant advances occurred over the last decades, it remains difficulty to accurately distinguish between benign (serous cystic lesions) and malignant or potentially malignant (mucinous cystic lesions) pancreatic cysts before resecting them. Mucinous cystic neoplasms (MCNs), intrapapillary mucinous neoplasms (IPMN) and serous cystic neoplasms (SCNs) can display differences when examined by imaging modalities, endoscopic ultrasonography (EUS) and cytological and biochemical analyses of cyst fluid. The performance characteristics of high-resolution computed tomography (CT) scanning and magnetic resonance imaging (MRI) in making these distinctions are, however, disappointing. The aim of this study is to evaluate the role of endoscopic ultrasound guided fine needle aspiration (FNA) in diagnosis of cystic pancreatic lesions and its accuracy in discrimination between benign, malignant and potentially malignant cysts.

Methods: The study was organized as a prospective study and conducted over 51 patients with identified cystic pancreatic lesions from prior radiological imaging (CT or MRI).

Results: EUS guided FNA has shown superior sensitivity, specificity, positive predictive value and negative predictive value in comparison to EUS alone in discriminating mucinous from non-mucinous cysts. This difference was remarkable specially for malignant cysts (mucinous cystadenocarcinoma, adenocarcinoma) and cystic lymphangioma. EUS-FNA associated with chemical and physical analysis of cyst fluid was 100% sensitive and specific. Cyst fluid CEA revealed significant importance in differentiating mucinous from non mucinous cysts. Cyst fluid amylase was significantly high in pseudocysts while mucin stain was important to discriminate mucinous from non-mucinous cystic lesions.

Conclusion: EUS-FNA has proven greater sensitivity and specificity, positive predictive, negative predictive value in differentiating mucinous and non-mucinous pancreatic cystic lesions as well as pathological categorization into subtypes.