Diagnosis of hydronephrosis or ureteral obstruction using renal sonography among patients with cervical cancer

@#<p style="text-align: justify;"><strong>Background:</strong> Cervical cancer is the second most common malignancy among Filipino women. The recent 2018 FIGO guidelines recommend imaging in cases of grossly invasive disease to determine the presence of hydronephrosis, which would immediately classify the disease as at least stage IIIB. CT and MRI are state-of-the-art modalities that can provide such information; however, these are costly and may not be accessible in areas with limited resources. Sonography is a safe and inexpensive alternative in this regard.</p><p style="text-align: justify;"><strong>Objective:</strong> This study aimed to evaluate the diagnostic performance of renal sonography in identifying the presence of ureteral obstruction or hydronephrosis among patients with grossly invasive cervical cancer, with non-enhanced CT as the reference standard.</p><p style="text-align: justify;"><strong>Methods:</strong> A blinded, prospective study was conducted among patients diagnosed with grossly invasive cervical cancer from the Philippine General Hospital. Participants underwent same-day evaluation with both renal sonography and non-enhanced CT. The presence of either ureteral obstruction or hydronephrosis secondary to cervical cancer was independently determined. The sensitivity, specificity, positive predictive value, and negative predictive value of renal sonography were calculated, with non-enhanced CT as the reference standard.</p><p style="text-align: justify;"><strong>Results:</strong> A total of 127 participants were enrolled. The mean age was 46 years, with a range of 24 to 65 years. The majority had stage IIB (41.7%) and stage IIIB (52.0%) disease. On non-enhanced CT, 46 (36.2%) showed evidence of ureteral obstruction or hydronephrosis, while 81 (63.8%) had negative results. On renal sonography, 46 (36.2%) had positive results, and 81 (63.8%) had negative findings. The sensitivity, specificity, and positive and negative predictive values of sonography were 91.3%, 95.1%, 91.3%, and 95.1%, respectively. Among patients with stage IIIB disease, sonography was shown to have higher sensitivity and specificity of 92.1% and 96.4%, respectively. Meanwhile, among patients with stage IB to IIB disease, its sensitivity and specificity were 87.5% and 94.3%, respectively.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Renal sonography has high sensitivity and specificity in the diagnosis of ureteral obstruction or hydronephrosis in patients with grossly invasive cervical cancer. Its sensitivity is higher when used in patients with stage IIIB disease, compared with those having lower-stage tumors.</p>

Relationship of serum vitamin D with liver disease severity and bone abnormalities in cholestatic children

@#<p style="text-align: justify;"><strong>Background:</strong> Vitamin D deficiency occurs in 10% to 36% of children with cholestasis. The relationship between serum vitamin D levels, severity of liver disease and bone abnormalities in children has not been extensively investigated.</p><p style="text-align: justify;"><strong>Objective:</strong> To determine serum vitamin D levels and its association with liver disease severity and presence of radiographic rickets in children with cholestasis.</p><p style="text-align: justify;"><strong>Methods:</strong> Children aged 0-10 years with cholestasis underwent serum 25-hydroxyvitamin D levels (25-[OH]D) determination, radiographs of wrists and knees and liver function tests. Liver disease severity was evaluated using the Child-Pugh score. Radiographs were assessed using Thacher Rickets Severity Score. Data were analyzed using odds ratio and Spearman's correlation coefficient.</p><p style="text-align: justify;"><strong>Results:</strong> We included 51 children [Mean (SD) age: 5 (6) months, 63% are males], mostly with biliary atresia (51%). Forty-seven (92%) had serum 25-(OH)D deficiency and four (8%) had insufficiency. Radiologic bone abnormalities were observed in 22 (43%) cases; specifically, rickets in 16 (31%). No association was observed with vitamin D levels and liver disease severity (OR 1.27, 95% CI 0.12-13.31) nor with rickets score (OR 0.07, 95% CI 0.004-1.37).</p><p style="text-align: justify;"><strong>Conclusion:</strong> Majority of the children with cholestasis had vitamin D deficiency, with a third having radiographic findings of rickets. Serum vitamin D levels were not associated with liver disease severity or with rickets score.</p><p style="text-align: justify;"><strong>Key Words:</strong> Vitamin D, rickets, cholestasis, bone disease, bone abnormalities</p>