Prevalence of Ultrasound-diagnosed Non Alcoholic Fatty Liver Disease Among Rural Indigenous Population in Malaysian and Its Association With Biochemical and Anthropometric Measures

@#Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide, especially in the Western world and Asia-Pacific regions. This study was designed to determine the prevalence of NAFLD detected by sonographic assessment among the rural indigenous population in Peninsula Malaysia and its association with anthropometric and biochemical factors. Methods: A cross-sectional survey was carried out from January 2014-February 2016. Subjects were recruited among indigenous peninsula Malaysia population in rural villages, aged ≥18 years old. The survey was questionnaire-based followed by anthropometric and blood parameters measurements. All subjects underwent abdominal ultrasound assessment to screen for the presence of NAFLD. Semi-quantitative visual grading was performed to assess for mild, moderate or severe NAFLD. Results: A total of 270 subjects underwent the screening program (mean age 43.3 ±14.0 years). Approximately 53 subjects (19.6 %) were identified with NAFLD. Of those with NAFLD, approximately 83% had moderate grade of fatty liver and the remainder were diagnosed with mild grade. NAFLD was closely associated with age, body mass index (BMI), central obesity, hypertension, total cholesterol (TC), triglyceride/high density lipoprotein-cholesterol (TG/HDL-C) ratio. On multivariate logistic regression, a high BMI (≥23.0 kg/m2), central obesity, and raised TG/HDL-C ratio were independent risk factors for developing NAFLD. Conclusion: This pioneer study defines the prevalence of NAFLD among rural indigenous population in Peninsula Malaysia. Lifestyle-related diseases, such as NAFLD can affect both rural and urban communities with equal severity. High BMI, central obesity, and elevated TG/HDL-C ratio were independent risk factors for developing NAFLD.

Acute Necrotizing Encephalopathy of Childhood: A Severe Case with Fatal Outcome

@#Acute necrotizing encephalopathy of childhood (ANEC) is a rare condition which is important for clinicians to recognize as it has a high mortality rate and can result in significant neurological morbidities. It presents as acute encephalopathy with radiological findings of symmetrical brain lesions in bilateral thalami, putamen, brain stem tegmentum, internal capsule, periventricular white matter and cerebellar medulla. Intravenous methylprednisolone is the mainstay of treatment. Immunoglobulin therapy and therapeutic hypothermia may be used as adjunctive therapy in cases with severe clinical and neuroradiological presentation. We present a case of severe ANEC and discuss the clinical manifestations, neuroimaging and management options.

One Stop Centre Staging by Contrast-Enhanced 18F-FDG PET/CT in Preoperative Assessment of Ovarian Cancer and Proposed Diagnostic Imaging Algorithm: A single centre experience in Malaysia

Introduction: Suspicious adnexal masses need to be investigated thoroughly as it may represent ovarian cancer, which is the fourth most common gynaecological cancer in Malaysia. Conventional cross sectional imaging may reveal non-specific findings, thus lead to unnecessary biopsies. 18F-Fluorodeoxyglucose positron emission tomography/ computed tomography (18F-FDG PET/CT) has emerged as a useful tool, for characterization of indeterminate adnexal masses. Most studies have been conducted in Western population, and little information is available in Asian population in general and Malaysian population in particular. Methods: Prospective study of women with suspicious adnexal masses, referred to the Centre for Nuclear Diagnostic Imaging, Universiti Putra Malaysia to undergo preoperative whole-body contrast-enhanced 18F-FDG PET/CT scans from January 2014 to January 2016. Subjects underwent Contrast-Enhanced Computed Tomography (CECT) scans followed by positron emission tomography (PET) scans using a hybrid scanner. Two radiologists analyzed the CECT and PET/CT images by consensus; blinded to the HPE results. Then the PET/CT findings were correlated with HPE results as the gold standard. Results: 11 wholebody PET/CT scans and 18 adnexal masses (12 HPE-proven malignant lesions and 6 benign lesions) were analyzed. The sensitivity, specificity, PPV, and NPV of CECT alone compared to PET/CT was 91.7%, 50.0%, 78.6%, and 75.0% vs. 91.7%, 100%, 100% and 85.7% respectively. Conclusions: Improved diagnostic accuracy for characterizing benign and malignant adnexal masses can be achieved using contrast-enhanced 18F-FDG PET/CT, making it a potential investigation of choice which can help in treatment planning.

MRI findings of orbicularis oculi hypertrophy due to heavy resistance training on the inferior orbital rim

Increase in cross-sectional muscle area of major muscle groups associated by heavy resistance training has been well documented. However, there has been no published article of changes in the inferior orbicularis oculi muscle when heavy resistance training is applied. We present a case of inferior orbicularis hypertrophy detected on MRI in a gentleman who practised heavy resistance training using his lower eyelids.