Most Cited

  • Epidemiology and Risk Factors for Hepatitis C Infection in Malaysia: A Narrative Review

    Hepatitis C infection is a growing public health issue in Malaysia. A large number of people living with hepatitis C virus (HCV) are unaware of the infection. The treatment complexity warrants a comprehensive understanding of this infectious disease to support planning for strategies to reduce the burden of disease associated with hepatitis C. This study aimed to summarise the epidemiology and risk factors attributable to hepatitis C acquisition in Malaysia based on local published articles. Published articles related to epidemiology and risk factors for hepatitis C infection in Malaysia between 2005 and 2017 were searched through several online databases. Related information from the Ministry of Health official website was also compiled. An increasing trend in the incidence and mortality rate of hepatitis C infection is noted over the last decades. In 2009, the national prevalence of people infected with HCV was approximately 2.5%, with the prevalence rate varying according to different high-risk groups. The most common genotypes reported are genotypes 3 and 1. Frequently reported risk factor for HCV acquisition is injection drug use. Other identified risk factors are being a blood product recipient, haemodialysis patient or participant in high-risk sexual activity. Nevertheless, a considerable number of patients had no known risk factors. The prevalence and burden of HCV-related disease are substantial and can be attributed to many factors. High-quality design studies are needed to provide stronger evidence of the risk factors for hepatitis C infection in local populations for future public health planning.

  • NECROTIZING FASCIITIS AT THE EXTREMITIES AND ITS MANAGEMENT

    We report in the light of a literature review the results of 28 patients treated for Necrotizing Fasciitis (NF) at the extremities between 2012 and 2017 with a view to a prospective study with longer following up and a greater number of patients.

  • Two-year Single-Center Real-Life Data of Tenofovir Disoproxil Fumarate Treatment for Chronic Hepatitis B Patients in Togo

    Objective: to evaluate the treatment efficacy of Tenofovir disoproxil fumarate (TDF) in patients with chronic hepatitis B (CHB) in the Teaching hospital campus of Lome. Patients and method: retrospective cross-sectional study, conducted in the outpatient department of the Hepato-Gastro-Enterology department of the Teaching hospital campus of Lome from January 2018 and December 2020. Patients with HBsAg were included. Outpatient patients having achieved at least HBeAg, anti-HBe antibody, anti-HCV antibody, anti-HBc IgG; viral load hepatic assessment; retroviral serology. Some patients had achieved actitest-fibrotest. Patients with abdominal pain, clinical signs of portal hypertension or hepatocellular insufficiency had achieved alphafetoprotein, protidogram, and abdominal ultrasound. These explorations made it possible to classify patients into different virological profiles. Results: More than sixty-four percent of the patients were male. The patients were asymptomatic at 97.37%. HBeAg was positive in 15.19% of patients. The viral load was detectable in 80.43% of cases with a value of 52000000 IU / ml +/- 280000000UI / ml. Ninety-five point twenty-four patients had an inflammatory activity less than 2 and 52.38% a fibrosis greater than 2 on the Metavir grid. The APRI and Fib-4 scores found a strong predictive value for fibrosis in 16.22% and 11.01% of cases, respectively. HBeAg negative chronic hepatitis was the most common virologic profile (58%). Cirrhosis was the most common complication (9.97%). Tenofovir was the therapeutic molecule used. At 12 months of treatment, HBe seroconversion was noted in 100% of cases, an undetectable viral load in 50% of cases and normalization of the hepatic balance in 84% of cases. No side effects of the treatment were reported Conclusion: TDF treatment shows high rate of complete virologic response in CHB patients. TDF is tolerable and safe during the 96 weeks of treatment period. Monitoring of HBV DNA level and drug adherence is important for achieving complete suppression…

  • COMPARISON OF THE EFFICACY OF SUBCISION WITH FRACTIONAL CARBON DIOXIDE LASER VERSUS SUBCISION WITH MICRONEEDLING FRACTIONAL RADIOFREQUENCY IN THE TREATMENT OF ATROPHIC POST ACNE SCARS

    Background: Many interventions have been used to treat post-acne scars, with various degrees of efficacy and adverse reactions. Multimodal approach can achieve better results for improving the physical appearance that even if minor may result in significant distress and reduced quality of life. Objective: To compare the efficacy of subcision with fractional carbon dioxide (CO2) laser and subcision with microneedling fractional radiofrequency (RF) in treating post-acne scars and to study their adverse effects. Methods: In this prospective, interventional clinical study, a total of 64 patients with post-acne scars were enrolled. The patients were randomly allocated into two groups of 32 patients each, in which group A was treated with subcision plus fractional carbon dioxide laser (CO2) and group B was treated with subcision plus microneedling fractional radiofrequency (RF) every 6 weeks for a total of four sittings. An objective score was calculated for each patient using the Goodman and Baron scale to evaluate the outcome every visit during treatment and then 3 months after completion of therapy. Results: In group A, the percentage reduction in the mean objective scores was found to be 64%. In group B, the percentage reduction in mean objective scores was found to be 42%. Most of the changes were seen in the boxcar and rolling types of scars. Conclusions: Subcision and fractional CO2 laser were considered superior over subcision with microneedling fractional (RF) technique for the treatment of post-acne scars. Boxcar and rolling types of scars showed a high response to treatment than icepick scars

  • Analysis of chosen factors affecting the incidence of a brain stroke – a preliminary report

    The risk of stroke is directly proportional to the occurrence of hypertension and the simultaneous occurrence of other risk factors. The main goal was to find out which age group was most at risk of having a stroke. The study was performed among 138 people randomly chosen from Michałowo borough in the Białystok county.The examined were divided into the following 5 age group. The following measurements were performed: arterial blood pressure, blood glucose level, total cholesterol and its fractions level, triglycerides level, sodium and potassium level, prothrombine time, activity. Additionally, a patient’s history was taken and an author’s survey questionnaire was completed. Due to the small number of men surveyed (13 persons), statistically significant analysis of data within this group cannot be carried out. An analysis was made, broken down by age, of data obtained after examining 125 women. People in age group III are most at risk of developing stroke. People in the IV and V age groups are those who are at risk of having a stroke or who have had a stroke. People in groups 1 and 2 are at moderate risk of stroke. In the III age group people are the most at risk of having a stroke.

  • Carnitine status before and after paracentesis in patients with ascites and liver cirrhosis and improvement of subjective symptoms by intravenous administration of carnitine ― Initial study

    Introduction: Recently, carnitine has been reported to be useful for improving blood ammonia and cognitive function in cirrhotic patients with subclinical hepatic encephalopathy In Japan, levocarnitine has become available, and there have been several reports in which the carnitine concentration was first measured and whether symptomatic patients improved or not . And, the examination of symptomatic state around the ascites centesis was also carried out. Method: Total carnitine concentration was measured in 5 cirrhotic patients undergoing ascites drainage during our hospital ambulatory, and after ascites drainage, intravenous administration of ercarnitine was conducted to examine whether or not the symptoms improved. Carnitine concentrations were measured before and after dialysis in four non-dialysis patients and one dialysis patient. Oral carnitine was administered in 3 patients (1 dialysis patient) because symptoms of cramps were noted, but in 2 cases. It was administered only after ascites drainage. Case presentation: The case was in a 55 year-old male. The chief complaint was persistent ascites, cramps and general malaise. The patient had a medical history of treatment with radiofrequency ablation (Radiofrequency: RFA) for hepatocellular carcinoma. The patient had been followed up at another hospital for chronic liver cirrhosis type C. Interferon therapy was performed for liver cirrhosis, resulting in a virological complete response (sustained virological response: SVR). The ascites storage was obvious, but the round was repeated from 2 to 3 times a week of golf. Because of frequent leg cramps during and at the end of golf, patients were given branched-chain amino acid preparations and liver protection drugs as oral medications. In a patient with liver cirrhosis, improvement of hepatic encephalopathy associated with decreased carnitine level and decreased ammonia were reported, and deterioration of muscle symptoms associated with carnitine deficiency in a dialysis patient was also reported [1-3]. Therefore, [4] Carnitine concentration and acylcarnitine/free carnitine…

  • A hypoechoic, tumor-like lesion in the pancreatic head and neck on endoscopic ultrasonography may be due to a high-grade pancreatic intraepithelial neoplasia/carcinoma in situ

    High-grade pancreatic intraepithelial neoplasia (HG PanIN)/carcinoma in situ (CIS) in the pancreatic body and tail can induce parenchymal atrophy through chronic inflammatory changes presenting as a Hypoechoic area on EUS (Hypocho) or focal pancreatic parenchymal atrophy (FPPA) on computed tomography (CT) and magnetic resonance imaging (MRI). We herein discussed two patients with a hypoechoic area in the pancreatic head and neck on EUS resembling pancreatic ductal adenocarcinoma (PDAC). The lesions consisted of dense fibrosis and fat infiltration with pancreatic parenchymal atrophy around the HG PanIN/CIS in the main pancreatic duct (MPD), which penetrated the lesion and showed mild stenosis and upstream dilation. CT and MRI were unable to visualize the lesions. A specimen was obtained from one lesion by fine-needle aspiration under EUS (EUS-FNA) guidance for histopathological and cytological analysis, but the tests returned negative for adenocarcinoma. However, serial pancreatic-juice aspiration cytologic examination (SPACE) revealed adenocarcinoma in both lesions, prompting surgical resection. Histopathological examination revealed non-invasive HG PanIN/CIS in the MPD surrounded by dense fibrosis and fat deposition in the area of parenchymal atrophy. The CIS was restricted to the area of parenchymal atrophy.These two cases are noteworthy in illustrating a hypoechoic area appearing on EUS as a tumor-like lesion resembling PDAC. EUS-FNA has recently been used histopathologically to diagnose a pancreatic lesion. However, in the present and similar cases, EUS-FNA can only reveal secondary changes due to CIS unless the pancreatic duct covered by the CIS is accidentally punctured. We should bear in mind that CIS can appear as a hypoechoic area resembling PDAC on EUS, and that SPACE is the best method for diagnosing CIS in such cases.

  • CHRONIC URTICARIA VERSUS DERMATOMYOSITIS IN A CASE OF T- CELL LARGE GRANULAR LYMPHOCYTIC LEUKEMIA

    Aim: The reported case involved a complicated diagnostic path, not only because of the usual difficulties specific to chronic urticaria but, also because the trigger was a T-cell large granular lymphocytic leukemia (T-LGLL), a rare type of leukemia with an indolent course whose etiology is still not well known. This leukemia is also known for its propensity to cause autoimmune diseases. The aim of this study was to identify whether the muscle damage was caused by dermatomyositis or by T-LGLL. Methods: After elevated muscle enzyme levels had been discovered magnetic resonance imaging (MRI) revealed muscle damage. Consequently, a muscle biopsy was performed in a targeted manner. In addition to muscle biopsy, transmission electron microscopy and anti-CN1A antibody testing were performed. Results: MRI of the lower limbs and pelvic girdle indicated moderate fibroadipose substitution in many muscles, moderate edema in others. No involvement of the shoulder girdle and upper limbs. Histological examination of the muscle fibers showed an “inflammatory myopathy with isolated phagocytotic fibers.” Inclusion-body myositis, which is known to be associated with chronic T-LGLL was excluded. On the same biopsy transmission electron microscopy confirmed inflammatory myopathy and anti-CN1A antibodies were positive. DNA extracted from the muscle of the micro-rearrangement for the y-chain of the TCR identified on the DNA extracted from peripheral blood was positive. Conclusions: Conclusions: Chronic urticaria was an indication of immunoproliferative disease. Myositis was the pathology due to T-LGLL, and dermatomyositis was excluded.

  • Colon Irrigation Bowel Preparation Supports Multiple Clinical Benefits in Over 8,000 Patients

    This retrospective clinical study evaluates an FDA-cleared high-volume colon irrigation bowel prep (BP) for colonoscopy, performed under standard operating procedures with Austin Gastroenterology (AG, Austin, TX). Patient related outcomes in 8,364 procedures, prescribed by 33 physicians in 4.5 years, demonstrated no serious adverse events and excellent satisfaction rates. The high level of adequacy using this BP far exceeds national benchmarking thresholds for adequate colon preparations. Adequacy rates remain high even when considering poor BP risk factors and patient noncompliance with ancillary pre-preparation regimens. Our analysis demonstrates that this colon irrigation BP has excellent Boston bowel preparation scores (BBPS), associated with high-level adenoma detection rates (ADR) and sessile serrated polyp (SSP) detection rates. ADR and SSP are inversely related to the patient’s post-colonoscopy interval colorectal cancer (CRC) risk, and are similarly related to an inadequate BP. Both modeling data and performance characteristics strongly suggest that this colon irrigation BP is highly safe, effective, and will reduce the costs and risks related to inadequate BP. This, accordingly, leads to significantly improved quality outcomes, savings to the healthcare systems, and a reduction of the patient’s burden.

  • A pilot study for using high-volume colon irrigation bowel preparation for colon capsule endoscopy shows feasibility of adequate bowel prep with high patient satisfaction

    A feasibility study was performed to test a bowel preparation (BP) method that would improve patients’ experience of colon capsule endoscope (CCE) while retaining clinical adequacy. Specifically, the use of high-volume colon irrigation with the Hygieacare® System, HygiPrep™, was tested in conjunction with Medtronic’s PillCam COLON 2 Capsule. This prospective, single-center, and IRB-approved study evaluated HygiPrep use prior to the PillCam COLON 2 procedure instead of the standard split-polyethylene glycol-electrolyte (PEG) oral prep. The study was performed at Austin Gastroenterology (Austin, TX), and all capsule video files were forwarded to a Central Reader to evaluate and compile a study report. Six of the seven (86%) subjects completed both the HygiPrep and PillCam COLON 2 exams and were graded as excellent, good, or adequate by the Central Reader. Patients’ feedback reported positive satisfaction scores for both the HygiPrep and the PillCam COLON 2 procedures. These results support our hypothesis that HygiPrep was as effective as Split-PEG BP. We suggest that the HygiPrep, is a suitable BP for CCE, providing adequate BP and high patient satisfaction.