Role of endoscopic ultrasound elastography in differential diagnosis of pancreatic solid masses.

INTRODUCTION: Endoscopic ultrasound (EUS) elastography is another technique that measures the stiffness of tissue and adds more diagnostic value to EUS. OBJECTIVE: This study aimed to assess the ability of qualitative and quantitative EUS elastography in differentiating malignant from benign solid pancreatic masses. METHODS: This 2-year cross-sectional study enrolled 80 patients with solid pancreatic masses in the department of endoscopy in Alassad University Hospital who underwent conventional and elastography-assisted EUS and then followed for pathology through EUS-guided or CT-guided biopsy or surgery. RESULTS: Qualitative elastography using a 5-point scoring system was able to recognize malignant pathology (obtained by EUS-guided biopsy, CT-guided biopsy, or surgery) with a sensitivity, specificity, and accuracy rates of 100%, 28.6%, and 81.3%, respectively. A quantitative method using hue histogram had a sensitivity of 71.2%-86.4% and specificity of 71.4%-81% with the best accuracy for histogram mean ratio (area under the curve, 0.867). CONCLUSION: EUS elastography is a simple and good alternative method in differentiating malignant from benign pancreatic solid masses.

Educational perspective for the identification of essential competencies required for approaching patients with COVID-19.

BACKGROUND: Health professionals are at the frontline of the COVID-19 pandemic and are directly exposed to infection hazards. Therefore, they should have the essential competencies for approaching patients. AIMS: The study aimed to identify essential competencies required for approaching patients with COVID-19. METHODS: All postgraduate health professionals at the Syrian Virtual University SVU (n=28) were invited to participate in the study during the Covid-19 lockdown in 2020, resulting in 20 postgraduates accepting. The Delphi technique was adopted for identifying competencies in medical education and a virtual meeting was undertaken through the University Management System in order to provide instruction and create a list of competencies. Competency domains were divided into 'knowledge', 'skills', and 'attitudes' and were classified into four categories: etiology, assessment and diagnosis, management, and prognosis. RESULTS: Fifty-two essential competencies were identified; 7 competencies on etiology, 7 related to assessment and diagnosis, 34 related to management, and 4 related to prognosis. CONCLUSION: It is hoped that the identified competencies would help health professionals to deliver the best health care for COVI-19 patients, as well as help policy-makers to support comprehensive training programmes that can equip health professionals with the required competencies to fight the pandemic.

Rare isolated primary peritoneal hydatid cysts: A case report from Syria.

Hydatid disease caused by Echinococcus granulosus is endemic in many regions of the world. The major primary site for the disease in adults is the liver and the secondary site are the lungs. Secondary peritoneal cysts are relatively common and expected to occur after rupture of the primary hepatic hydatid cyst. Primary peritoneal hydatid cyst disease without any other organ involvement has been previously reported, and yet it is still considered rare even in endemic areas. A case of a large primary peritoneal hydatid multicystic lesion without other organ involvement in a 25-year-old girl seen at the gastrointestinal outpatient clinic in the University of Kalamoon Medical City is presented and discussed. The disease was very extensive but surgical intervention was refused due to the patient being a young unmarried female. The patient was treated and observed over a period of ten months. She responded very well to medical treatment with albendazole. The case emphasizes the importance of hydatid disease being included in the differential diagnosis of any cyst in the abdominal cavity for patients living or coming from an area of endemic hydatid disease even without liver or lung involvement. This also goes to show that it can respond to medical treatment, which becomes even more valuable in conditions where surgical intervention might not be an option.