Jordan Medical Journal

Demographic features and diagnostic criteria of Primary Eosinophilic Colitis among adult patients with emphasis on clinicopathological correlation

Heyam Awad — 2021-12-01

Objective Primary Eosinophilic Colitis (PEC) is the rarest and least understood entity in the spectrum of eosinophilic gastrointestinal diseases. This study aims at describing the clinicopathological characteristics of this disease and to explore histological criteria that can improve its diagnostic accuracy. Methods: In this retrospective clinico-pathological study, we describe the clinical and histological features of 22 cases of PEC. The computerized system of the Histopathology Department at Jordan University Hospital was searched for cases diagnosed as tissue eosinophilia (130 cases). The medical records were reviewed to check the final diagnosis and only cases with PEC were included. The demographic features were documented, and all the histopathological slides were reviewed and the main histological features, mainly the number of eosinophils per high power field were recorded. Results: 16.9% of cases of tissue eosinophilia turned out to be PEC. These were distributed equally between genders with the median age being 49.5 years. The most common presentation was diarrhea and/or abdominal pain. Colonoscopy was normal in 72.7 % of cases. 40.9% of Patients had associated allergic conditions, mostly milk intolerance, and 18.2 % had peripheral eosinophilia. Histologically there was dense eosinophilic inflammation with features of eosinophil activation including degranulation and eosinophilic cryptitis and crypt abscesses. There was no correlation between the density of the eosinophilic infiltrate and these histological features. Conclusion: Gastroenterologists and pathologists should keep a high index of suspicion when faced with cases of unexplained diarrhea and/ or abdominal pain. Pathologists reporting colonic biopsies should actively search for eosinophils in the colonic biopsies when faced with such history. However, diagnosis cannot be made on histological grounds alone, and clinico-pathological correlation is essential to diagnose PEC after excluding all possible secondary causes.

Recurrence monitoring in Egyptian Bladder Cancer patients using effective and predictive urinary molecular biomarkers: A pilot study

Neemat Kassem — 2021-12-01

Background In Egypt, Urinary bladder cancer (UBC) ranks the 3rd most common cancer, being the second among males and the 7th among females. One relevant mechanism to decrease mortality rate of UBC is to detect its local recurrence through using commercially available effective molecular biomarkers. Purpose We evaluate the diagnostic sensitivity and specificity of the Xpert BC Monitor test in Egyptian patients with non muscle invasive BC. Methodology Liquid biopsies in the form of voided urinary samples were analyzed using the Xpert BC Monitor Kit, measuring the levels of five target mRNAs (ABL1, CRH, IGF2, UPK1B, ANXA10) by RT-PCR in 20 Egyptian patients. Results Two patients (10%) were females and 18 (90%) were males with median age of 66 years. About 80% of the urine samples that were tested in this pilot study were successfully analyzed. Six patients (30%) had positive test results, while 10 patients (50%) had negative test results, 6 of them had radiological evidence of disease. Invalid test results were found in 4 patients (20%). Thus, the test showed 60% sensitivity with 100% specificity and giving positive predictive value of 100% with negative predictive value of 60%. Conclusion Using the non-invasive liquid biopsy method represents a promising tool to improve the current standard of care in patients with non muscle invasive bladder cancer. Further prospective randomized trials with larger patient series and longer follow up period are needed to establish the superiority of Xpert BC Monitor test over the current standard of care in Egyptian BC patients.

Time Trends of Brain Tumors in Jordan: Age at Diagnosis, Gender and Histological Type

Ahmad Tamimi — 2021-12-01

In Arab Countries, including Jordan, limited descriptive brain cancer data is available. We investigated the time trends of brain tumors with respect to gender and histological type distribution and age at our institution over the 1981-2011 period. We found a slight male predominance (52%, P< 0.05) throughout the study period for all tumors combined, with more pronounced male predominance for glioblastoma multiforme, anaplastic astrocytoma and oligodendroglioma. Meningioma and pinocytoma showed female predominance (P<0.05). The gender distribution was stable for all histological types over the entire 30-year period. Relative frequency of all histological types was stable over the 30-year period except for anaplastic astrocytoma. However, the absolute numbers of cases diagnosed at the hospital increased in 18 of the 42 different types of tumors identified, peaking in 1990-1991 and in 2003-2006. Mean age at diagnosis for the study population was 35.2 years. Age at time of diagnosis increased overtime for craniopharyngiomas, colloid cysts and pinocytomas but remained stable for the remaining tumors. Aside from only a few exceptions, our study demonstrates stability of the various brain tumor types in Jordanians with respect to gender, histological type distribution and age at diagnosis over a long period of time.

Clinical characteristics of asthmatic children with Vitamin D deficiency at Jordan University Hospital: A retrospective study

Enas Al-Zayadneh — 2021-12-01

Objective: Bronchial asthma is the most common chronic condition in the pediatric population around the world. Increasing evidence suggests an association between Vitamin D deficiency and asthma. This study aims to evaluate the prevalence of vitamin D deficiency in children with bronchial asthma in Jordan University Hospital, investigate the clinical characteristics of the study population, and examine the correlation between vitamin D levels and asthma severity and control. Methodology: A retrospective chart review was conducted on 201 asthmatic children, aged 1 to 18 years, who received medical care at Jordan University Hospital from 2015 to 2018. Vitamin D levels were recorded for all study populations. Patient demographic and clinical characteristics such as body mass index, feeding status, pulmonary function test, and pediatric intensive care admissions were collected. Demographic and clinical characteristics were compared among three categories of vitamin D levels, and a correlation between asthma severity and vitamin D level was assessed. Results: Out of 201 participants included in the study, 51.7% were vitamin D deficient, 26.6% were vitamin D insufficient, and 21.6% were vitamin D sufficient. The following variables had significant correlations with vitamin D levels; frequency of inhaled Salbutamol usage (p=.028), PICU admissions (p=.011), feeding status at six months (p=.039), and the number of admissions per year (p=.028).Conclusion: Vitamin D deficiency is prevalent in asthmatic children and correlates with the severity and control of asthma in our target population. Health care providers of asthmatic children are encouraged by our results to assess vitamin D levels in these patients.

Effects of metformin and cinnamon on 1,5 anhydroglucitol, adiponectin and ghrelin on newly diagnosed type 2 diabetes mellitus patients

Shatha Mohammad — 2021-12-01

Backgrounds and Aims: Cinnamon, is one of the commonly used herbs for T2DM in spite of variable evidence. This study aimed to show the effect of cinnamon when combined with metformin on the glycemic marker; serum 1,5 anhydroglucitol, and the metabolic syndrome markers; adiponectin and ghrelin, in newly diagnosed type 2 diabetes mellitus patients. Materials and Methods: This is a randomized controlled trial study that has been conducted over 12 weeks. It included 57 males and females who were, 32-60-year-old. States that may affect the results were excluded. Group 1 patients (n. 30) were treated with metformin alone (500 mg) three times daily. Group 2 patients (n. 27) were treated with metformin 500mg three times daily and cinnamon, 3capsules per day (each capsule contained 1000 mg of crude cinnamon powder) for 12 weeks. A control group of apparently healthy subjects were used for comparing the results. Results: Metformin group showed a significant rise in 1.5AG level (p 0.028) and an insignificant rise in ghrelin and adiponectin levels. However, the metformin plus cinnamon group showed a significant rise in 1,5AG (0.017) and ghrelin (p 0.041) and a highly significant rise in adiponecting level (p value 0.009) that approached the control group level. Conclusion: adding, crude cinnamon to metformin produced significant improvement in 1,5anhydroglucitol and ghrelin levels and highly significant improvement in adiponectin level, suggesting that crude cinnamon is a beneficial adjunctive therapy in treating T2DM and metabolic syndrome. Key words: 1,5 anhydroglucitol, Adiponectin, Cinnamon, Ghrelin, Metformin

Correlations between Central Corneal Power, Axial Length, Anterior Chamber Depth and Central Corneal Thickness of near-Emmetropic Young University Students in Palestine

Mohammed Aljarousha — 2021-12-01

Purpose: To investigate the correlation between the central corneal power (CCP) and a panel of variables which include axial length (AL), axial depth of the anterior chamber (ACD), and the central corneal thickness (CCT) in emmetropic eyes in young students in the Optometry Lab of the Islamic University-Gaza (IUG), Palestine. Methods: In a prospective analysis, 200 emmetropic students were examined from February to May 2019 by the Ultrasound Scanner (A-scan), Ultrasonic Pachymeter, and Visionix L79 Automated Refractometer Keratometer (ARK)-Topography machines. Only the data of one eye was randomly chosen for investigation. The age range was 18-23 years with spherical equivalent (SE) refractive error of less than ± 0.50 D. Results: The means and standard deviations (SD) of the CCP, AL, ACD, and CCT of the near-emmetropic male students (n=97) were 43.19 ± 1.34 D, 23.54 ± 0.68 mm, 3.59 ± 0.26 mm, and 549 ± 33 µm , respectively. In addition, the means ± SD in female subjects in 103 near-emmetropic female students of CCP were 43.85 ± 1.43 D, AL 22.94 ± 0.69 mm, ACD 3.35 ± 0.25 mm, and CCT 543 ± 35 µm. There was a significant association between CCP and gender (p=0.00). However, there was no significant difference in CCP values between the age groups (p=0.49). There was a negative significant correlation between CCP and AL for both the males (r=-0.64; p=0.00) and the females (r=-0.71, p=0.00) participants. The values of the correlation (r) were 0.15 and 0.08 between CCP and ACD of the male and female participants respectively. Additionally, no significant correlation was found between CCP and CCT for male and female eyes (p=0.16, p=0.86, respectively). Conclusion: This study provided information for CCP, AL, ACD, and CCT in near-emmetropic eyes in young students in the optometry lab at the IUG, Palestine. Scores of CCP was normally distributed. CCP was not significantly influenced by age, ACD and CCT. In male students CCP was flatter, and AL was longer when compared with female Palestinian young students

Retroperitoneal liposarcoma causing upper gastrointestinal bleeding

Sara Haj Ali — 2021-12-01

Retroperitoneal sarcomas are rare tumors that usually present with abdominal discomfort and palpable mass. They rarely present with gastrointestinal bleeding. Here, we report a case of retroperitoneal liposarcoma presenting with upper gastrointestinal bleeding secondary to gastric invasion. A 70-year-old lady with recurrent history of retroperitoneal liposarcoma and multiple previous surgical resections and radiotherapy presented with melena for one week. Upper endoscopy revealed a fungating mass in the gastric body, the biopsy of which confirmed liposarcoma. Few days later, the patient developed abdominal pain and fever. CT scan of the abdomen showed perforated stomach with abdominal collection. This responded well to drainage and intravenous antibiotics. Gastric perforation following diagnostic upper endoscopy is extremely rare and mostly associated with predisposing factor like malignant tumors. Endoscopists should be aware of the risk and avoid excessive air insufflation or looping of the scope in such patients.