ABSTRACT
Background: Carbohydrate antigen (CA) 19-9 is considered as a tumor marker in biliary-pancreatic malignancy. Though a high level may indicate the presence of a malignant disorder, it may rise even in benign condition. Similarly, the value may be normal even in malignant condition.Methods: An observational comparative study was conducted in the Department of Surgery of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from 01 June 2016 to 31 May 2017 to find out the sensitivity and specificity of CA 19-9 as a tumor marker in pancreatic malignancy in our perspective and to find out a cut-off value of CA 19-9 which might prove as a definitive indication of pancreatic malignancy.Results: The study shows when the cut off value of CA 19-9 is 37 U/ml. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) were 77.8%, for all four characteristics respectively. But if the serum CA 19-9 threshold used to diagnose pancreatic cancer was raised to 100 and 120, sensitivity decreased to 72.2% and 66.7% and NPV decreased to 76.2% and 73.9% respectively. However, specificity increased to 88.9% and 94.4% and PPV increased to 86.7% and 92.3% respectively.Conclusions: Serum CA 19-9 level may be considered as an important determinant in the diagnosis of malignant pancreatic diseases and to assess the resectability of the lesions preoperatively, but other adjuncts are necessary in the overall management of pancreatic diseases.
ABSTRACT
Brain tryptophan is low in fibromyalgia. Intake of protein rich in large neutral amino acids is reported to lower brain tryptophan. This study was undertaken to assess whether any reduction of such proteins by exclusion of animal protein from the diet reduced pain and morbidity in fibromyalgia patients. It was an open, randomized controlled trial. 37 subjects with fibromyalgia were enrolled in the vegetarian diet and 41 in the amitriptyline groups. The outcome was assessed with the help of frequencies of fatigue, insomnia & non-restorative sleep, pain score on a 10-point VAS and tender point count. Fatigue, insomnia and non-restorative sleep were present in 41, 26 and 32 subjects before and in 3, 0 and 0 subjects respectively at six weeks of treatment in the amitriptyline group. The pain score and tender point count were 6.2 +/- 1.9 & 16.1 +/- 2.3 before and 2.3 +/- 1.3 & 6.4 +/- 3.0 after treatment. All these differences were significant (P < 0.001). In the vegetarian diet group, fatigue, insomnia and non-restorative sleep were present in 36, 24 and 27 subjects before and in 34, 29 and 29 subjects at six weeks of treatment. The pain score and tender point count were 5.7 +/- 1.8 and 15.7 +/- 2.4 before and 5.0 +/- 1.8 & 14.7 +/- 3.6 after treatment. All these differences were insignificant except that in the pain score. The decrease in the pain score, though significant, was much smaller than that in the amitriptyline group. So, it may be concluded that vegetarian diet is a poor option in the treatment of fibromyalgia.