Gastric Cancer and Paraneoplastic Pemphigus

Paraneoplastic pemphigus is a relatively rare but significant acquired autoimmune mucocutaneous disorder that is characterised by diffuse erythema, painful blistering and sores of the skin and mucus membranes. The underlying pathogenesis is believed to be triggered by altered immune system in response to underlying neoplasm. The manifestations can predate, occur at the same time or after the diagnosis of cancer. Associations with gastric cancer have only been reported twice. A 78-year-old lady presented with a month’s history of extensive skin lesions that started off as bullous lesions and biopsy revealed bullous pemphigus. Endoscopy for anemia revealed gastric cancer. This case reinforced the need to consider underlying malignancy in elderly patient with new onset dermatological presentation.     

Swimming-induced pulmonary oedema an uncommon condition diagnosed with POCUS ultrasound

Swimming Induced Pulmonary Edema, or SIPE, is an emerging condition occurring in otherwise healthy individuals during surface swimming or diving that is characterized by cough, dyspnea, hemoptysis, and hypoxemia. It is typically found in those who spend time in cold water exercise with heavy swimming and surface swimming, such as civilian training for iron Man, triathalon, and military training. We report the case of a highly trained young female swimmer in excellent cardiopulmonary health, who developed acute alveolar pulmonary oedema in an open water swimming training diagnosed in the emergency department using POCUS ultrasound.     

Explaining the variation in the management of lifestyle risk factors in primary health care: A multilevel cross sectional study

Background  

Despite evidence for the effectiveness of interventions to modify lifestyle behaviours in the primary health care (PHC) setting, assessment and intervention for these behaviours remains low in routine practice. Little is known about the relative importance of various determinants of practice.     

Neurotoxicity in Russell’s viper (Daboia russelii) envenoming in Sri Lanka: a clinical and neurophysiological study

Context: Russell’s viper is more medically important than any other Asian snake, due to number of envenoming’s and fatalities. Russell’s viper populations in South India and Sri Lanka (Daboia russelii) cause unique neuromuscular paralysis not seen in other Russell’s vipers. Objective: To investigate the time course and severity of neuromuscular dysfunction in definite Russell’s viper bites, including antivenom response. Methodology: We prospectively enrolled all patients (>16 years) presenting with Russell’s viper bites over 14 months. Cases were confirmed by snake identification and/or enzyme immunoassay. All patients had serial neurological examinations and in some, single fibre electromyography (sfEMG) of the orbicularis oculi was performed. Results: 245 definite Russell’s viper bite patients (median age: 41 years; 171 males) presented a median 2.5?h (interquartile range: 1.75–4.0?h) post-bite. All but one had local envenoming and 199 (78%) had systemic envenoming: coagulopathy in 166 (68%), neurotoxicity in 130 (53%), and oliguria in 19 (8%). Neurotoxicity was characterised by ptosis (100%), blurred vision (93%), and ophthalmoplegia (90%) with weak extraocular movements, strabismus, and diplopia. Neurotoxicity developed within 8?h post-bite in all patients. No bulbar, respiratory or limb muscle weakness occurred. Neurotoxicity was associated with bites by larger snakes (p?<?0.0001) and higher peak serum venom concentrations (p?=?0.0025). Antivenom immediately decreased unbound venom in blood. Of 52 patients without neurotoxicity when they received antivenom, 31 developed neurotoxicity. sfEMG in 27 patients with neurotoxicity and 23 without had slightly elevated median jitter on day 1 compared to 29 normal subjects but normalised thereafter. Neurological features resolved in 80% of patients by day 3 with ptosis and weak eye movements resolving last. No clinical or neurophysiological abnormality was detected at 6 weeks or 6 months. Conclusion: Sri Lankan Russell’s viper envenoming causes mild neuromuscular dysfunction with no long-term effects. Indian polyvalent antivenom effectively binds free venom in blood but does not reverse neurotoxicity.     

Analysis of a thread used in the Kshara Sutra treatment in the Ayurvedic medicinal system

From a Kshara Sutra thread which is used in the therapy of fistula in the Ayurvedic medicinal system, euphol, 3,12-di-O-acetyl-8-O-benzoylingol, 3,12-di-O-acetyl-8-O-tigloylingol, curcumin, p-coumaroylferuloylmethane and di-p-courmaroylmethane were isolated and characterized. In addition, GLC and GC/MS confirmed the presence of euphol, antiquol B, cycloeucalenol and 24-methylene cycloartanol in the thread.     

Profiles of autoimmune hepatitis in Brunei Darussalam

BACKGROUND:Autoimmune hepatitis(AIH)is a chronic inflammatory disease of the liver.Data on the disease remain scarce in the Southeast Asia region.This study was undertaken to assess the profiles of AIH in Brunei Darussalam.METHODS:Nineteen patients with AIH treated at the hepatology clinic,RIPAS Hospital(up until December 2008)were reviewed.Demographic,laboratory,histologic,clinical,and therapeutic data of the patients were collected.RESULTS:The median age of the 19 patients at diagnosis was 52 ye...     

Investigation of cardiovascular risk factors in type 2 diabetes in a rural Australian Division of General Practice

OBJECTIVE: To examine the changes in cardiovascular disease (CVD) risk factors for a cohort of patients with type 2 diabetes in general practice. DESIGN AND SETTING: A 4-year retrospective cohort study using extracted data from an active Division of General Practice diabetes register in Australia. PARTICIPANTS: 628 patients (297 female; 331 male) with type 2 diabetes who participated in the diabetes program of the Southern Highlands Division of General Practice and for whom evaluation data were recorded each year from 2002 to 2005. MAIN OUTCOME MEASURES: Changes in the following CVD risk factors over time: body mass index (BMI), serum lipid levels (total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], total triglycerides [TG]), systolic and diastolic blood pressure (BP), and glycated haemoglobin (HbA(1c)) level. RESULTS: After adjusting for age, sex, duration and clustering, there was significant improvement in serum lipid levels (TC and LDL-C; P < 0.05) over time; and there was no significant change in BP, HbA(1c) level or BMI. Older patients had significantly worse systolic BP, but significantly better BMI and lipid levels than younger patients. Longer duration of diabetes was associated with worse systolic BP and HbA(1c) level, but better HDL-C level. People with higher BMI were likely to have worse systolic BP, and HDL-C and HbA(1c) levels, but better TC level than those with lower BMI. CONCLUSIONS: Improving BP, HbA(1c) level and BMI may be more difficult than improving lipid levels. There is a need for more intensive and comprehensive interventions to reduce the total risk of CVD.     

Profile of HER2 ve Gastric Cancers in Brunei Darussalam

Background: Gastric cancer is the second most common gastrointestinal cancer and is still associated with significant morbidity and mortality due to late presentation and diagnosis at advanced stages. Studies have reported that a variable proportion of gastric cancer is positive for the human epidermal growth factor receptor 2 (HER2) and patients with HER2 positive (HER2 ve) lesions can benefit from targeted therapy. This study was conducted to assess the prevalence of HER2 ve gastric cancers in Brunei Darussalam, a developing Southeast Asian nation. Materials and Methods: Patients were identified from the Department of Pathology registry and retrospectively reviewed. HER2 expression was assessed by immunohistochemistry and only those staining 3 were considered positive. Results: Our study included 103 cases (66 males and 37 females) with a mean age of 65.1 14.8 years old. There were 14 cases positive for HER2 (10 males and 4 females) giving a prevalence of 13.6%. The HER2 ve cases were significantly older (70.6 19.3 years old) than the negative cases (64.2 13.8, p=0.041) and had significantly more advanced disease (stages 3 and 4, p=0.026). There were no significant differences in gender distribution, presence of intestinal metaplasia, EBV status, Helicobacter pylori status, tumor location (proximal vs. distal) and degree of tumor differentiation (all p values >0.05). Conclusions: Our study showed that 13.6% of our gastric cancers are positive for HER2, the affected patients being older and having more advanced disease at diagnosis.