Effects of a Low-Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyol Diet on Symptoms of Functional Abdominal Pain in Pediatric Patients / 대한소아소화기영양학회지

Purpose@#Recently, great interest has been focused on dietary fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) for the treatment of functional abdominal pain (FAP). Several meta-analyses, including those on the adult population, have been published, potentiating its role. However, pediatric studies are scarce. We aimed to evaluate the effect of a low-FODMAP diet on the severity of FAP in children. @*Methods@#This clinical trial included 50 patients aged 3–18 years with irritable bowel syndrome and FAP that were not otherwise specified. The patients were instructed to receive a low FODMAP diet guided by a dietitian. The primary outcome was the percentage of responders after 2 months of dietary intervention compared with baseline. Other outcomes included changes in stool consistency and quality of life (QoL) scores using the KIDSCREEN-10 questionnaire, and weight-for-age z-scores. @*Results@#After the dietary intervention, 74% of patients showed more than 30% lower pain intensity, as examined using the Wong-Baker Faces pain rating scale. Their QoL significantly improved, and patients have gained weight. @*Conclusion@#A low FODMAP diet can improve pain intensity and QoL among children with functional abdominal pain, with no detrimental effects on body weight.

Role of elastography strain ratio and TIRADS score in predicting malignant thyroid nodule

ABSTRACT Objective: Ultrasonography (US) is the most accurate and cost-effective imaging method in diagnosis of thyroid nodules. A practical thyroid imaging reporting and data system (TIRADS) for thyroid nodules has been proposed to classify nodules of the thyroid gland to solve the problem of nodule selection for fine needle aspiration cytology (FNAC). Real-time elastography and strain ratio (SR) is a method used to assess the stiffness and predict the malignancy of thyroid nodules. The objective of this study was to assess the role of elastography and SR and the TIRADS scoring system in discriminating malignant from benign thyroid nodules. Materials and methods: From 2015 to 2018 at Cairo University Hospital, a series of 409 patients with thyroid nodules was referred to undergo thyroid ultrasound. Categorization of each nodule according to the TIRADS ranged from 1 to 5. The qualitative elastography score and semiquantitative SR of the nodules were evaluated. Final diagnosis was done by either post-thyroidectomy histopathological examination or US-guided FNAC. Results: Our study included 409 patients with thyroid nodules. Their mean age was 39 ± 10 SD; 36 were males and 373 were females. There were 22 malignant nodules and 387 benign nodules. There were statistical differences between benign and malignant nodules regarding TIRADS classification, SR, anteroposterior/transverse ratio, degree of echogenicity, border, presence of calcification, and absence of halo sign (P < 0.001). The elastic properties of thyroid nodules proved to be a good discriminator between malignant and benign nodules (P- < 0.001) at a cut off value of > 2.32 with 95.2% sensitivity and 86.5% specificity. For every unit increase in SR, the risk of malignancy increased by nearly 2 times. Patients with irregular borders had nearly 17 times increased risk of malignancy than those with regular borders. Conclusion: Elastography and SR proved to be of high significant value in discriminating benign from malignant nodules, so we recommend adding it to the TIRADS classification.

A Comparative Assessment Of Serum Creatinine And Cystatin C As A Significance Of Nephropathy In Diabetic Patients

@#The critical micro-vascular complications of diabetes ultimately result in renal dysfunction known as diabetic nephropathy (DN). Measurement of glomerular filtration rate (GFR) is considered to be an important parameter in renal function assessment, evaluating GFR by Creatinine level. Recently, Cystatin C is used as a substitute indicator in several studies to assess diabetic nephropathy. This work was conceived to determine whether serum cystatinC would replace serum creatinine (Scr) in patients with type2 diabetes for early evaluation of nephropathy. A Case-Control Study was enrolled on 30 Patients with diabetic and 30 apparently healthy as control, aged between 25 - 83 years. Levels of serum cystatine C and serum Creatinine were calculated for both groups. Serum Creatinine, as well as serum cystatin C levels, was significant relationship with diabetic pt. in compared to non-diabetic individuals. ROC analysis noted the cystatinC was more predict indicator in diagnosed Diabetic Nephropathy (DNP) from Serum Creatinine level. In Type 2 diabetics, CystatinC is a good marker for uncontrolled diabetic nephropathy relative to serum creatinine.

Comparison of endoscopic ultrasound and computed tomography for detecting and staging malignant pancreatic masses

Introduction: Endoscopic ultrasound [EUS] is now established as a valuable imaging test for diagnosing and staging pancreatic cancer. But, with significant recent improvements in spiral computed tomography [CT] scanners, particularly higher resolution and ability to reconstruct 3D images, spiral CT is now increasingly accepted as being better for pancreatic cancer staging. The debate continues, however, about the best diagnostic test or combination of tests in patients with suspected pancreatic cancer. Spiral CT is more readily available than endoscopic ultrasound guided fine needle aspiration [EUS-FNA], cheaper and, therefore, more frequently used In this study, we evaluated the use of EUS-FNA in comparison with spiral CT for detection and staging of malignant pancreatic massesMethods: This prospective study was carried in El-Ebrashi unit of Gastroenterology and Hepatology, Internal Medicine department, Cairo University over 3 years from 2011 to 2014. It included 68 patient with suspected pancreatic mass lesions based on abdominal ultrasound, CT or MRI and patients with obstructive jaundice due to common bile duct [CBD] stricture as proved by endoscopic retrograde cholangiopancreatography [ERCP] or Magnetic resonance cholangiopancreatography [MRCP]. The patients were subjected to dual phase pancreatic control multi-detector computed tomography [MDCT] to be followed by EUS-FNA, then cytopathological examination of the studied patients to determine the nature of pancreatic masses, normal and benign cases are followed up after 6 months by EUS for exclusion of malignancy

Results: The final diagnosis in this study was that, 61 patients were malignant and 7 benign cases. The sensitivity of CT was 75% compared to 100% for EUS. While the specificity for CT was 14% compared to 100% for EUS. The negative predictive value for CT was 6.25% compared to 100% for EUS. With an overall accuracy of MDCT was 69% compared to 100% for EUS for diagnosing pancreatic cancer. The sensitivity of CT for detection of small lesions

Conclusion: EUS is more accurate than CT for detection of pancreatic cancer especially in small tumors. EUS is more accurate than CT in staging of pancreatic cancer in early stages

Recommendation: Early diagnosis of pancreatic cancer is the most important step in the way of decreasing its mortality rate. For screening of patients with suspected pancreatic cancer, initially CT should be performed to be followed by EUS whether to exclude masses in negative CT patients or to confirm the mass and to provide a tool for sample/or cytopathological diagnosis in patients with positive CT We recommend a future study to correlate the accuracy of staging by EUS and CT with post-operative histopathological staging

Role of endoscopic ultrasound [EUS] and EUS-guided-fine needle aspiration in diagnosis of mediastinal and abdominal lymphadenopathy

Background and aim: Endoscopic ultrasound [EUS] and the subsequent EUS-guided fine needle aspirate [EUS-FNA] represent a major breakthrough in interventional methods especially for sampling suspicious-appearing lymph nodes. Therefore, we aimed to evaluate the diagnostic yield EUS-FNA in setting of a given abdominal and/or mediastinal lymph nodes. Also, to detect the echo- features that may predict lymph node malignant potentials

Methods: Between January 2014 and May 2015, all consecutive patients with intra-abdominal and/or mediastinal lymphadenopathy were enrolled. EUS-FNA was carried out and the aspirate then sent for cytological and histological studies and Immune stains [IHC]. EUS-FNA results were categorized into benign or malignant. The gold- standards for final diagnosis were the postoperative pathological results or the follow-up course

Results: during the period of the study, a total of 86 patients [50 males, mean age 57.62 +/- 8.47] were enrolled. No major complications were reported. The main proven final diagnoses of the LNs were pancreatic cancer [34.88%, n=30], and cholangiocarcinoma [12.8%, n=11] and 75.6% [n=65] were malignant. The sensitivity, specificity, and accuracy rates of EUS-FNA were 95.38%, 100%, and 95.5%, respectively [No false positive cases]. The multivariate Binary logistic regression revealed that only the echo-texture [odds ratio 29.8; P=0.003] and short axis diameter of the lymph nodes [odds ratio 1.6; P=0. 025] are the most predictors of malignant potentiality

Conclusions: EUS-FNA is an accurate and safe method for diagnosis of abdominal and mediastinal lymphadenopathy

Computed tomography evaluation of paranasal sinuses lesions

The goal of this study is to evaluate the role of computed tomography scan in the diagnosis of sinuses diseases. This was a cross-sectional study design, conducted in different hospitals and clinical centers at Khartoum State. Totally 26 males and 24 females aged ranges from 10 to 70 years old with different symptoms were selected, axial and direct coronal cuts were done for all cases. The study revealed that most patients were affected in the both sides, with a history of sinuses diseases in their families, maxillary sinuses are the most affected area, and most patients suffer from headache. Chronic and fungal sinusitis the sensitivity of the coronal view was [77%, 61%, and 61%] respectively compared to axial that was [22%, 36%, and 38%] respectively In the nasal polyp and granulomatous diseases, the efficiency of the coronal view was [62% and 65%] respectively, while in axial was [37% and 34%] respectively. In benign and malignant tumor the efficiency of coronal was 57% and 32% respectively, while in the axial view was [42% and 21%] respectively. This study concluded that the two image planes are performed together and used as an essential technique of peripheral nerve stimulation

Endosonography as a predictive tool for first oesophagogastric variceal bleeding

Endosonography [EUS] is a useful tool for evaluating the fine details of the vascular structures at the gastroesophageal junction. The aim of this study is to evaluate the value of extraluminal gastroesophageal vascular collaterals as predictors for first variceal bleeding. Fifty cirrhotic patients with no history of previous upper gastrointestinal [GI] bleeding were recruited into this prospective cohort study. All patients were subjected to upper endoscopy and EUS for assessing the number and size of extramural vascular collaterals and perforating vessels. All patients were followed up for 24 +/- 7.5 months for upper gastrointestinal bleeding. Eighteen out of 50 patients [36%] had at least one attack of upper GI bleeding during the follow up period. All patients had one or more types of extraluminal venous collaterals. The presence of gastric varices [p = 0.02], perigastric collaterals [p = 0.03] and perforators [p = 0.02] were independent risk factors for first variceal bleeding. The presence of 3 or more paraoesophageal collaterals and the presence of perforators were significantly higher in bleeders when compared to non-bleeders [p = 0.034]. Perigastric and paragastric collateral sizes were significantly larger in bleeders than in non-bleeders [p = 0.019 and 0.038, respectively]. Perigastric and paragastric collaterals of size more than or equal to 2 mm and 6.20 mm, respectively were associated with significantly increased risk of first variceal bleeding. EUS may be a promising tool for predicting first variceal bleeding in cirrhotic patients