Endoscopic Ultrasound Guided Fine-Needle Aspiration for Solid Lesions in Chronic Pancreatitis: A Systematic Review and Meta-Analysis.

BACKGROUND: Patients with chronic pancreatitis (CP) are at a higher risk of developing pancreatic adenocarcinoma compared the general population with an estimated 5% risk of developing pancreatic cancer in 20 years. Endoscopic ultrasound fine needle aspiration (EUS-FNA) of solid pancreatic lesions (SPL) has an excellent sensitivity (85-90%) and specificity (98-100%) for diagnosing pancreatic malignancy. However, data on the performance characteristics of EUS-FNA in CP are mixed. AIMS: In this systematic review and meta-analysis, we aim to examine data from published studies on the diagnostic performance of EUS-FNA in detecting pancreatic malignancy in CP. METHODS: We conducted a comprehensive search of MEDLINE, Cochrane, EMBASE, Scopus databases for studies published in English language that reported performance characteristics of EUS-FNA for SPL up to November 2020. Two reviewers independently conducted screening, full text review and data extraction according to the PRISMA guidelines. Quality of included studies was assessed using the risk of bias in non-randomized studies of interventions (ROBINS-I) tool. The parameters of interest were sensitivity, specificity, negative, and positive likelihood ratios. Cochran Q test and I statistics were used to determine the between-study heterogeneity. Funnel plots were used to describe publication bias. RESULTS: A total of 6753 studies were identified on initial search. Studies that reported EUS-FNA of cystic pancreas lesions were excluded. Eight studies met the inclusion criteria. Seven studies were retrospective, and one was prospective. A total of 593 patients with CP underwent EUS-FNA for SPL. The pooled sensitivity of EUS-FNA was 65% (95% CI 52.6-75.6%, I2 = 44%), specificity was 96.8% (75-99.7%, I2 = 89%), negative likelihood ratio (NLR) 41.4 (11.1-149.6, I2 = 70%), positive likelihood ratio (PLR) 24.1 (2.8-208, I2 = 90%). The pooled data from seven studies that compared 901 non-CP vs. 127 CP showed that the sensitivity of EUS-FNA in diagnosing pancreatic malignancy was 91.5 vs. 65.3% [OR (95% CI) 5.5 (2.9-10.2), I2: 31.8%]. The specificity pooled from six studies [333 non-CP vs. 357 CP] was 95.9% vs. 82.4%, [OR (95% CI) 1.3 (0.2-9.8), I2 = 73%]. The risk of bias was serious in one study, low in four studies and moderate in three studies. CONCLUSION: This pooled meta-analysis shows a low sensitivity of EUS-FNA in diagnosing malignancy in CP patients with SPL in comparison to patients without CP. Modalities such as EUS-fine needle biopsy have high sensitivity and specificity for diagnosing pancreatic cancer and should be considered in patients with CP and suspected pancreatic malignancy.

Phytochemical and pharmacological profile of genus shorea: A review of the recent literature.

In tropical Southeast Asia, Shorea is the most economically important tree and the largest genus in the Dipterocarpaceae family. It comprises about 150-200 species, of which majority are distributed in Malaysia, with others found in Sumatra and Borneo (Kalimantan) in Indonesia. Research on the chemical constituents of Shorea plants has been ongoing for many years. To date, a total of 113 different compounds, including 83 stilbenes and their resveratrol oligomers, 18 triterpenes/terpenoids, 7 coumarins 3 flavonoids and 2 steroids have been isolated and successfully elucidated from 26 different species of this genus. The diversity of the stilbene resveratrol oligomers in the Shorea genus is primarily due to the difference in the amount of resveratrol constituent units, which include dimers, trimers and tetramers. In addition to the species' traditional usage in the treatment of illnesses, such as diarrhea, toothaches, skin diseases, ear troubles and wounds, the extracts and secondary metabolite compounds isolated from various parts of the plant species are known to have a very potent antioxidant, antimicrobial, anticancer, anti-diabetic, anti-obesity, antiulcer, hepatoprotective and nephroprotective activities. This review aims to summarize the most recent research made from 1999 to date on the secondary metabolite compounds isolated from different species of genus Shorea, as well as the bioactivity (in vitro and in vivo) of the crude extracts and the isolated secondary metabolite compounds.

COVID-19, Hypertriglyceridemia, and Acute Pancreatitis: A Case Report and Clinical Considerations.

Acute pancreatitis (AP) is a serious condition that can result in numerous negative outcomes including death. The underlying causes of AP are varied, with both COVID-19 and hypertriglyceridemia being documented in the medical literature. Here, we present the case of a young man with a pre-existing diagnosis of prediabetes and class 1 obesity who developed severe hypertriglyceridemia, AP, and mild diabetic ketoacidosis while concurrently infected with COVID-19. It is crucial for healthcare providers to be vigilant in recognizing the potential complications associated with COVID-19, regardless of whether the patient has received a vaccination.

Trends in pediatric tuberculosis diagnosis utilizing xpert Mycobacterium tuberculosis/Rifampicin in a poor-resource, high-burden region: A retrospective, multicenter study.

Background: The burden of tuberculosis (TB) in Nigeria remains high, and diagnosis in children, a challenge. We aimed to document yield from Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) as a mode of diagnosis for children and the variables associated with a positive result. Methods: This was a retrospective review of TB treatment cards of children aged 0-15 years managed from January 2017 to December 2021 across six public tertiary institutions in Nigeria. The data obtained were analyzed using the descriptive and inferential statistics. Statistical significance was set at P < 0.05. Results: Of 1489 children commenced on TB treatment, 1463 (97.9%) had sufficient data for analysis the median age of study participants was 60 months (interquartile range [IQR]: 24, 120), and 814 (55.6%) were males. Xpert MTB/RIF test was performed in 862 (59%) participants and MTB was detected in 171 (19.8%) participants, of which 6.4% (11/171) had RIF resistance reported. The use of Xpert MTB/RIF rose from 56.5% in 2017 to 64% in 2020 but fell to 60.9% in 2021. We found that older age (> 10 years), the presence of pulmonary TB (PTB), and a negative human immunodeficiency virus (HIV) status were associated with positive Xpert MTB/RIF tests (P = 0.002, 0.001, and 0.012, respectively). Conclusion: The utilization of Xpert MTB/RIF in children increased in the years before the COVID-19 pandemic. Factors associated with MTB detection by Xpert MTB/RIF include older age, the presence of PTB, and a negative HIV status. Clinical and radiological evaluation continues to play vital roles in the diagnosis of childhood TB in Nigeria.

The first report of Histophilus somni pneumonia in Nigerian dairy cattle.

Clinical signs of severe bronchopneumonia, including anorexia, coughing, nasal discharge, dyspnoea, diarrhoea, distension of the neck, lethargy, recumbency, lameness preceding collapse, and death were observed among a herd of Holstein-Friesian dairy cattle. The outbreak occurred over a 30-day period, and attack and case-fatality rates were 0.4% and 50%, respectively. At necropsy, extensive consolidation in the cranioventral parts of the lungs was observed. Histologically, a severe acute bronchopneumonia with slight pleuritis was present. Both pathological and bacteriological evaluation of the lungs incriminated Histophilus somni (heavy growth). Supplementary laboratory investigations also isolated Clostridium and Klebsiella species (scanty growth) from the lungs. Histophilosis in cattle was confirmed for the first time in Nigeria.

Is Z division of the Achilles tendon always necessary in wide exposure of the back of the distal tibia and ankle joint? Report of a preliminary investigation.

BACKGROUND: In posterior approach to the back of tibia and ankle, mere retraction of the Achilles tendon can expose the operation site but when this exposure is not enough, Z division of the Achilles tendon is recommended in literature. The main objective of the study is to find out if Z division of the Achilles tendon is always necessary in posterior approach to the back of tibia and ankle for direct vision of the back of distal tibia, exploration of bones and joints of the posterior aspect of the ankle joint. METHOD: From 15/12/1997 to 30/12/2006 sixteen patients required surgical management of distal tibia fractures involving articular surfaces. Posterior approach with Achilles tendon division was indicated for satisfactory access to the back of tibia and ankle. In equal number of these patients division of the Achilles tendon was either by Z or longitudinal divisions. Intra and post operative assessment of both types of Achilles tendon division was done. RESULTS: Longitudinal division of the Achilles tendon had advantages and should be preferred. Operation time, period of post- operative pain and cast immobilization were brief. There was full range of motion of the ankle joint after removal of cast. CONCLUSION: When division of the Achilles tendon is indicated for direct vision of the posterior aspect of the distal of tibia and ankle joint, Z division is not necessary. A good knowledge of anatomy and experience makes the procedure easier and quicker.

Successful Trial of Octreotide and Ketorolac for the Management of Increased Biliary Drain Output: A Case Report.

We describe a 69-year-old male patient with the status of obstructive jaundice post percutaneous biliary drainage for prior obstructive jaundice and who presented with a complaint of generalized weakness and increased output from the drainage tube. The patient developed worsening jaundice, which was noted to be obstructive in nature with a marked dilatation of the biliary tree and a distal obstruction of the common bile duct. Subsequently, a percutaneous biliary drain was placed for symptomatic management. However, the patient continued to have increased output from the drain, approximating 3-4 liters a day, which made the patient dependent on continuous intravenous hydration. The case presented a therapeutic challenge in reducing the drainage amount. We have tried a successful approach based on the physiologic effect of octreotide and nonsteroidal anti-inflammatory drugs (NSAIDs) in the formation of bile secretion. This approach has not been clearly described in the literature. We highlight the importance of further study to validate the use of these medications in similar clinical scenarios.

A Rare Case of Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma Transforming into Diffuse Large B-Cell Lymphoma.

Mucosa-associated lymphoid tissue lymphoma (MALToma) is a low grade B-cell lymphoma that develops from the lungs, intestinal tract, salivary gland, and other organs and is included under extranodal marginal zone lymphoma. When a primary pulmonary MALToma develops from bronchus-associated lymphoid tissue (BALT), it is called BALT lymphoma (BALToma). The etiology of MALToma is not clear; however, an association between chronic inflammatory conditions and BALToma has been observed. Transformation of MALToma to high grade lymphoma is very rare. We experienced a case of MALToma that had developed from the lungs in a patient who was undergoing treatment for latent tuberculosis and rapidly transformed into high grade B-cell lymphoma.

What does the geometry of an arc reveal about methods of assessing spinal radiographs in scoliosis?

BACKGROUND: The shapes of an arc and scoliosis are the same. Therefore, the geometry of an arc can reveal the relationship between the angles within and around a scoliotic spine. OBJECTIVE: To look for angles which are functions of the geometry of an arc and can also be used for assessment of curve progression in scoliosis. DESIGN: Review of the geometry of an arc and that of scoliosis. METHOD: English literature on scoliosis (from 1930 to date), searched manually, via Internet and from colleagues, was reviewed. RESULTS: Methods of curve measurement in use presently are functions of the geometry of scoliosis. Three additional methods are proposed for assessment of curve progression in scoliosis. These methods are geometrically related with the previously known ones. CONCLUSION: All methods of assessment of curve progression in scoliosis are fundamentally the same and interchangeable. There is no reason for preference of one method over another method of curve measurement.

Phytochemical screening and anticonvulsant studies of ethyl acetate fraction of Globimetula braunii on laboratory animals.

OBJECTIVE: To investigate the phytochemical properties and the anticonvulsant potential of the ethyl acetate soluble fraction of ethanol leaf extract of Globimetula braunii, a plant used in ethnomedicine for the treatment of epilepsy. METHODS: The phytochemical screening was carried out using standard protocol while the anticonvulsant activity was studied using maximal electroshock test in chicks, pentylenetetrazole and 4-aminopyridine-induced seizures in mice. RESULTS: The preliminary phytochemical screening carried out on the crude ethanol extract revealed the presence of saponins, carbohydrates, flavonoids, tannins, anthraquinones and steroids. Similarly, tannins, flavonoids and steroids/terpenes were found to be present in the ethyl acetate fraction. In the pharmacological screening, 150 mg/kg of the fraction protected 83.33% of animals against pentylenetetrazole-induced seizure in mice whereas sodium valproate a standard anti-epileptic drug offered 100% protection. In the 4-aminopyridine-induced seizure model, the fraction produced a significant (P<0.05) increase in the mean onset of seizure in unprotected animals. The fraction did not exhibit a significant activity against maximal electroshock convulsion. The median lethal dose of the fraction was found to be 1 261.91 mg/kg. CONCLUSIONS: These results suggest that the ethyl acetate fraction of Globimetula braunii leaves extract possesses psychoactive compound that may be useful in the management of petit mal epilepsy and lend credence to the ethnomedical use of the plant in the management of epilepsy.

Monteggia fracture-dislocation: a case report, its' initial management and review of bado's classification.

Fracture of proximal ulna and dislocation of the proximal radio-ulna joint in the same arm is called Monteggia fracture- dislocation. Four clinical variants of this fracture- dislocation have been described in literature. This is a report and description of initial management of a fracture- dislocation, which was consequent to a sideswipe injury and consisted of a combination of the following injuries; lateral dislocation of the radial head, fractures of the olecranon and proximal ulna in the left forearm. The radial head dislocation and fracture of the olecranon were open. The head of the radius was exposed through the same wound. This fracture-dislocation resembled type 3 Bado's classification of Monteggia fracture-dislocation because of fracture of the olecranon close to the coronoid process and lateral dislocation of the head of radius.