Pancreatic cancer is one of the most lethal cancers, and continues to be a major health problem in the twenty-first century. Early-stage disease is usually clinically silent, or manifests with non-specific symptoms that often go unrecognised; therefore, diagnosis is invariably dependent on imaging methods. Although transabdominal ultrasound imaging (TAUS) is frequently the first-line diagnostic approach for patients presenting with jaundice and/or upper abdominal pain, computerized tomography (CT) is the most commonly used imaging method for the diagnosis and staging of pancreatic cancer. The more sensitive multiphase, multidetector helical CT constitutes the method of choice. In addition, magnetic resonance imaging (MRI) can also detect primary pancreatic tumours as well as regional and distant metastases, and, in recent years, positron emission tomography (PET) – stand-alone or in combination with CT – has been established as a useful adjunct. Recently, endoscopic ultrasonography (EUS) has gained popularity as a promising staging modality, and it currently has a complementary role to CT for the evaluation of patients with pancreatic cancer. Nevertheless, despite recent technologic advancements in the diagnostic approach to pancreatic cancer and the refinement of the clinical staging algorithm, early diagnosis remains challenging and a substantial improvement in patient outcomes has not yet been observed.

Pancreatic cancer is among the most difficult cancers to manage owing to a lack of early symptoms, early metastatic spread and debilitating cachexia quite unlike that seen in most other tumours. Up to 80% of patients will have metastatic or locally advanced disease at the time of presentation and therefore the mainstay of management in the majority of cases is symptomatic with or without the addition of systemic treatment, depending on patient factors. This review focuses on oncological strategies for advanced pancreatic cancer from standard gemcitabine-based therapies to the more recently reported molecular profiling-based strategies that are becoming the mainstay of treatment in recent years. In a disease with such a guarded prognosis, symptom management and maximizing quality of life is of utmost importance; here, we also review the multidisciplinary management of biliary obstruction, gastric outlet obstruction, pain, cachexia and the risk of thromboembolism.

Pancreatic cancer is one of the top 10 cancers in terms of incidence, and continues to be associated with poor 5-year survival. Surgery for localized disease provides the best treatment option with potential for cure. This article discusses pre-operative management, and the evidence for and against biliary drainage prior to surgery, indications for the different types of pancreatic resections and variations in surgery based on evolution of techniques over time, including the extent of lymphadenectomy. The diverse options for reconstruction and their merits are highlighted and the evidence for and against post-operative drainage is presented. Aspects of perioperative management are discussed, with emphasis on complications specific to pancreatic surgery, the role for enhanced recovery and use of somatostatin analogues. The evidence for centralization is outlined, and measures to improve outcomes following these complex resections are detailed.

Primary well-differentiated neuroendocrine tumour (NET) (carcinoid tumour) of the urinary bladder is extremely rare and most clinicians would be unfamiliar with its presentation, investigation, pathological classification, management and treatment outcomes. The aim of this article is to review the literature on reported cases of primary well-differentiated NETs of the urinary bladder. Bladder NETs due to metastasis from other sites and mixed-bladder NETs were excluded from the literature search. Fewer than 20 cases of primary well-differentiated NETs of the urinary bladder have been reported in the literature. A total of 18 cases were reviewed, with 28% of the cases discovered as an incidental finding. The mean age of the patients at presentation was 56 years (range: 30–73 years). There was no sex predilection. The size of the tumour ranged from 2 to 50 mm. The mean follow-up was 24 months. This tumour tends to present with haematuria, with transurethral resection as a modality of treatment with good results. Histological examination of reported cases of well-differentiated NETs of the urinary bladder have exhibited histological characteristics similar to primary well-differentiated NETs that are found in sites outside the urinary bladder. Primary well-differentiated NETs (carcinoid) of the urinary bladder are very rare and have similar histological characteristics to those of carcinoid tumours in other sites of the body. They predominantly present with haematuria, appear to have excellent prognosis and are amenable to transurethral resection.

Participation in type 2 diabetes mellitus self-management education (DSME) is crucial for individuals with type 2 diabetes mellitus in order to develop and maintain behaviours that prevent or delay the complications of type 2 diabetes mellitus. Despite the high prevalence of type 2 diabetes mellitus in the United Arab Emirates, studies investigating barriers to participation in lifestyle educational programmes are lacking. The purpose of this study was to examine barriers to patients' regular participation in the ‘Skills for Change’ Diabetes Nutrition Education Program. In this cross-sectional descriptive study, 109 Emirati adults (mean age: 53.7 ± 8.76 years) who participated in the ‘Skills for Change’ Diabetes Nutrition Education Program between November 2011 and March 2013 were interviewed. Survey participants were recruited from the three intervention health centres in Al Ain where the ‘Skills for Change’ programme was implemented. The survey questionnaire was developed by the research team from the existing literature on barriers to type 2 diabetes mellitus education services and was pre-tested before use. Time constraints caused by other commitments, transportation issues and moving out of the health centre area were the three main reasons mentioned by the survey participants as barriers to regular participation in the ‘Skills for Change’ programme. Not being responsible for cooking food at home (59.6%), not easy to change diet because of family preferences (50.5%) and social gatherings (42.9%) were the major barriers to making the recommended dietary changes. The primary reason for lack of participation in the group physical activities was changing to another health centre (42.1%). On the other hand, only 10.5% of the respondents felt that the health care team did not spend enough time explaining the recommendations, and only 13.3% felt that the exercise was too difficult to perform. The majority of the respondents considered the availability of dietitians (88.6%) and exercise facilities (81%) in the health centres to be very important or important. The findings of this study can be useful for the development of future community-based education programmes for Emirati adults with type 2 diabetes mellitus.

Chlamydia trachomatis, a leading cause of blindness, remains hyperendemic in the poorer regions of the world. In Egypt, the disease represents a major health problem. The objective was to assess the active trachoma and actual ocular C. trachomatis infection as diagnosed by its isolation in the Vero cell line followed by its detection using Giemsa stain, iodine stain, enzyme-linked immunosorbent assay (ELISA) and Gen-Probe. Forty patients clinically diagnosed with chlamydial conjunctivitis were collected from the outpatient clinic of the Ophthalmology Centre, Mansoura University Hospital, Egypt. Two scrapings were taken, one fixed onto a slide for direct Giemsa stain and the other transported on sucrose phosphate medium to be cultured on the Vero cell line then identified by Giemsa and iodine stains, ELISA and Gen-Probe. C. trachomatis was detected by direct Giemsa stain in 1/40 (2.5%) of samples but isolated in the Vero cell line and identified in 4/40 samples (10%) by Giemsa and iodine stains or Gen-Probe. However, ELISA identified only 2/40 (5%) of total samples after culture. Direct Giemsa stain provided low sensitivity (25%) and a high specificity (100%) compared with cell cultures, with high statistically significant differences between both tests (P-value<0.001). All the indices for Gen-Probe in relation to Giemsa stain for chlamydial identification after culture were 100%. Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) and efficiency of chlamydial culture identification by ELISA as related to Giemsa stain identification were 50%, 100%, 100%, 94.7% and 95%, respectively, with high statistically significant differences between both tests (P-value<0.001). C. trachomatis was detected in a relatively high rate of acute follicular conjunctivitis patients as detected with culture on the Vero cell line. Identification of C. trachomatis in culture was 100% by Giemsa and iodine stains or Gen-Probe but only 50% by ELISA. Direct Giemsa stain demonstrated low sensitivity (25%) and high specificity (100%).

The aim of this study was to evaluate the profile of liver biopsies in a tertiary referral centre in eastern India. A total of 54 patients over a period of 1 year, diagnosed by clinical, biochemical, radiological and histopathological parameters, were evaluated for aetiology. Investigations included serological tests for the markers of hepatitis B virus (HBV) and hepatitis C virus (HCV). Autoimmune markers, including antinuclear antibody (ANA), antismooth muscle antibody (ASMA) and antimitochondrial antibody (AMA-M2), were carried out where clinically indicated. Histopathological study with routine haematoxylin and eosin (HE) stain and special stains, including Masson's trichrome and reticulin stain, were carried out. A total of 24 (46%) patients had non-alcoholic fatty liver disease (NAFLD), 18 (34%) patients had chronic viral hepatitis and 10 (20%) patients had other liver disorders. HBV was present in 16 (88.2%) cases and HCV in 2 (11.8%) cases in the category of clinically chronic viral hepatitis patients. None had infection with both viruses. Cholestatic liver disease, cirrhosis and amyloidosis were the aetiological factors, amongst others. Biopsy was inadequate in two cases. This study showed NAFLD, closely followed by HBV infection, as the most common cause of liver disease in the study population. Alcoholics were excluded from the study. The study reflects the referral pattern in a tertiary centre. However, larger and longer studies are required to delineate the exact prevalence of liver disease in this geographical area.

We present an unusual case of severe early neonatal hyperbilirubinaemia, for which congenital hypothyroidism was diagnosed as the cause. This form of hyperbilirubinaemia was unusually treated using two courses of exchange transfusion.