A Scoping Review of the Prevalence of Fascioliasis in Malaysia and Risk Factors for Infection

@#This review aimed to provide a comprehensive overview of ruminant and human fascioliasis in Malaysia and to identify research gaps in knowledge of the prevalence of fascioliasis in Malaysia and risk factors for the disease using available evidence-based data. We conducted a scoping review based on the framework of Arksey and O’Malley. The preferred reporting items for systematic reviews and meta-analyses were used to guide the review process. The citation search was performed between May and September 2018. Using specific keywords, literature published between 1998 to September 2018 was retrieved from electronic databases. Six articles related to fascioliasis in Malaysia were included in the final review from 1,932 screened articles and reports. Five studies focused on ruminants, including cattle, buffaloes, sheep and goats in the states of Terengganu and Perak. The most frequent ruminant fascioliasis outbreaks involved cattle and goats, with a prevalence of 82%–95% and these outbreaks occurred in Terengganu. Only one study examined the risk of fascioliasis in cattle. In the study, the age and sex of the cattle were important risk-related parameters. The search returned only one documented report of a suspected case of human fascioliasis with an atypical clinical presentation. At present, human fascioliasis in Malaysia remains under-reported and its prevalence remains unknown. The data summarised in this review based on existing evidence identifies research gaps on fascioliasis in ruminants and humans.

Airway reconstruction: review of an approach to the advanced-stage laryngotracheal stenosis / Reconstrução de via aérea: revisão de uma abordagem à estenose laringotraqueal em estágio avançado

Abstract Introduction: The management of laryngotracheal stenosis is complex and is influenced by multiple factors that can affect the ultimate outcome. Advanced lesions represent a special challenge to the treating surgeon to find the best remedying technique. Objective: To review the efficacy of our surgical reconstructive approach in managing advanced-stage laryngotracheal stenosis treated at a tertiary medical center. Methods: A retrospective review of all patients that underwent open laryngotracheal repair/reconstruction by the senior author between 2002 and 2014. Patients with mild/moderate stenosis (e.g. stage 1 or 2), or those who had an open reconstructive procedure prior to referral, were excluded. Patients who had only endoscopic treatment (e.g. laser, balloon dilatation) and were not subjected to an open reconstructive procedure at our institution, were not included in this study. Variables studied included patient demographics, clinical presentation, etiology of the laryngotracheal pathology, the location of stenosis, the stage of stenosis, the type of corrective or reconstructive procedure performed with the type of graft used (where applicable), the type and duration of stent used, the post-reconstruction complications, and the duration of follow-up. Outcome measures included decannulation rate, total number of reconstructive surgeries needed to achieve decannulation, and the number of post-operative endoscopies needed to reach a safe patent airway. Results: Twenty five patients were included, aged 0.5 months to 45 years (mean 13.5 years, median 15 years) with 16 males and 9 females. Seventeen patients (68%) were younger than 18 years. Most patients presented with stridor, failure of decannulation, or respiratory distress. Majority had acquired etiology for their stenosis with only 24% having a congenital pathology. Thirty-two reconstructive procedures were performed resulting in decannulating 24 patients (96%), with 15/17 (88%) pediatric patients and 5/8 (62.5%) adult patients requiring only a single reconstructive procedure. Cartilage grafts were mostly used in children (84% vs. 38%) and stents were mostly silicone made, followed by endotracheal tubes. The number of endoscopies required ranged from 1 to 7 (mean 3). More co-morbidities existed in young children, resulting in failure to decannulate one patient. Adult patients had more complex pathologies requiring multiple procedures to achieve decannulation, with grafting less efficacious than in younger patients. The pediatric patients had double the incidence of granulation tissue compared to adults. The decannulated patients remained asymptomatic at a mean follow-up of 50.5 months. Conclusion: The review of our approach to open airway repair/reconstruction showed its efficacy in advanced-stage laryngotracheal stenosis. Good knowledge of a variety of reconstructive techniques is important to achieve good results in a variety of age groups.

Resumo Introdução: A conduta da estenose laringotraqueal é complexa e é influenciada por vários fatores que podem afetar o resultado final. Lesões em estágio avançado representam um desafio especial para o cirurgião encontrar a melhor técnica de tratamento. Objetivo: Avaliar a eficácia de nossa abordagem de reconstrução cirúrgica no tratamento de estenose laringotraqueal em estágio avançado em um centro médico terciário. Método: Revisão retrospectiva de todos os pacientes submetidos a tratamento cirúrgico/reconstrução laringotraqueal aberta pelo autor principal, entre 2002 e 2014. Os pacientes com estenose leve (por exemplo, estágio 1 ou 2) ou aqueles submetidos a procedimento de reconstrução aberta antes da indicação foram excluídos. Pacientes que tinham sido submetidos somente a tratamento endoscópico (por exemplo, laser, dilatação por balão) e não haviam sido submetidos a procedimento de reconstrução aberta em nossa instituição não foram incluídos. As variáveis estudadas incluíram dados demográficos dos pacientes, apresentação clínica, etiologia da doença laringotraqueal, local da estenose, estágio da estenose, o tipo de procedimento corretivo ou reconstrutor feito com o tipo de enxerto usado (onde aplicável), tipo e duração do stent usado, complicações pós-reconstrução e duração do seguimento. Os resultados incluíram taxas de decanulação, número total de cirurgias reconstrutoras necessárias para possibilitar a decanulação e o número de endoscopias pós-operatórias necessárias para obter uma via aérea patente e segura. Resultados: Vinte e cinco pacientes foram incluídos, com 0,5 meses a 45 anos (média de 13,5, mediana de 15) com 16 homens e nove mulheres. Dezessete pacientes (68%) eram menores de 18 anos. A maioria dos pacientes apresentava estridor, falha de decanulação ou desconforto respiratório. A maioria das estenoses era adquirida, enquanto apenas 24% apresentavam causa congênita. Trinta e dois procedimentos reconstrutores foram feitos, resultaram em decanulação de 24 pacientes (96%), com 15/17 (88%) pacientes pediátricos e 5/8 pacientes (62,5%) adultos que necessitaram de apenas um único procedimento reconstrutor. Enxertos de cartilagem foram usados principalmente em crianças (84% vs. 38%) e a maioria dos stents era feita principalmente de silicone, seguido por tubo endotraqueal. O número de endoscopias necessárias variou de um a sete (média de três). Mais comorbidades foram observadas em crianças pequenas, o que resultou em falha de decanulação em um paciente. Pacientes adultos apresentavam doenças mais complexas que requereram vários procedimentos para decanulação, com enxertos menos eficazes do que em pacientes mais jovens. Os pacientes pediátricos apresentaram o dobro da incidência de tecido de granulação em comparação com os adultos. Os pacientes decanulados permaneceram assintomáticos em um seguimento médio de 50,5 meses. Conclusão: A revisão da nossa abordagem para tratamento cirúrgico/reconstrução aberta das vias aéreas demonstrou eficácia na estenose laringotraqueal em estágio avançado. O conhecimento de uma variedade de técnicas de reconstrução é importante para conseguir bons resultados em vários grupos etários.

pattern of tuberculosis in Aswan Chest Hospital, Egypt

Objective/background: Tuberculosis [TB] is a major health problem. The aim of this study was to examine the pattern of TB in Aswan Chest Hospital, Aswan, Egypt. Methods: This cross-sectional study was carried out using medical records from the TB registry in Aswan Chest Hospital. The investigated variables included demographic characteristics, type of TB infection, and affected organs. All data were coded and statistically analyzed

Results: The average age of the 557 patients infected with TB was 40.31 +/- 18.87 years; 58.2% of the cases were men and 41.8% were women. In both sexes, the highest number of TB patients was from the reproductive age groups

During the 5-year study period, the highest percentage of cases were new cases and the highest frequency of cases was during 2011 and the lowest frequency was during 2015

Pulmonary TB cases showed a sharp decline; however, there was a decrease in extrapulmonary TB cases during 2012 and 2013, with a slight rise in 2014 and 2015. Of the pulmonary TB cases, 82.5% were smear-positive TB

Conclusion: There was a decline in the total number of TB cases across the studied years and the most studied cases were pulmonary smear-positive and new cases. Younger people represented a large percentage of reported cases

[Lymph node dissection in gastric cancer]

To review local experience in dissecting regional lymph nodes during gastric cancer surgery and it's impact on prognosis and 5 years survival. This was a retrospective study of all patients having gastric resection for cancer at the University of Damascus hospitals between 2001 and 2007. 180 patients were reviewed with age ranging from 30 to 70 years, and a 2:1 male predominance [120 males and 60 females]. Patients were divided into three groups according to the level of lymph nodes dissected: 1-Dissection of the lymph nodes adjacent to the gastric wall and the nodes around the celiac and hepatic trunks [N3]. 2-Dissection of adjacent and celiac nodes [N2]. 3-Dissection of adjacent nodes only [N1]. Over five years follow up, local recurrence was observed three times more in the third group compared with the first two, with the lowest observed recurrence noted in the group having all three levels dissected. The number of nodes dissected during total gastrectomy was twice as that in patients having sub-total resections. There was a direct correlation between 5 years survival rates in patients having all three levels of lymph nodes dissected and the number of involved lymph nodes. It is advisable to dissect of all the three levels of nodal drainage basins during gastric resection for cancer to reduce local recurrence and therefore to improve survival. Regardless of the type of gastric resection performed, the number of total lymph nodes dissected should not be less than 15 nodes

[ colon-anal anastomosis with temporary protective colostomy for lower rectal tumors following preoperative radiotherapy]

The aim of this study was to evaluate the local experience in preserving the anal sphincter in patients with low rectal tumors using manual colo-anal anstomosis, protected with a temporary colostomy, after a preoperative course of radiotherapy. Fourty-two [42] patients were followed up in our teaching hospitals included in this study, during the period between 1999 and 2002. Their tumors was lower than 15 cm from anal sphincter [<15cm] on the rigid sigmoidoscope, these patients were divided into three groups: the first group: 7 patients in whom the lower edge of the tumor was 5 cm from the anus, they were given preoperative course of radiotherapy. The second group: 15 patients, in whom the tumor was 5-7 cm from the anus, they were also given a course of preoperative radiotherapy. The third group: 20 patients, their tumor was higher than 8 cm from the anus, they had immediate surgical treatment without radiotherapy prior to surgery. The interim period between surgery and radiotherapy was 30 days, and patients were given 40 gray during three weeks. Patients were followed-up for [8-48] months, there was no deaths, no fistula and no perineal infection during the convalescence period, there was left colon necrosis in one case, and early stenosis in the anastomosis in another. Local recurrence was evident in five patients; it was controlled in one case by abdomino-perineal resection. The functional results, were good in 66.6% after two years of follow-up. The patients had an average of three stools per day after one year, the average of total survival rate for four years was 83.3%. It is possible to preserve the anal sphincter with low colo-anal anastomosis for the treatment of tumors of the lower third of the rectum with the help of a preoperative radiotherapy, with good results on the functional and canerous levels, as an alternative treatment to abdomino-perineal resection in selected patient

Validity of fetal pulse oximetry in predicting fetal outcome in patients with non-assuring external fetal heart rate monitoring

To assess the sensitivity and predicitive values of fetal pulse oximetry in predicting fetal outcome in patients with non-assuring CTG. Women with singleton fetus and non-assuring fetal heart rate pattern during active phase of the first stage of labor were randomised into two groups; case and control. All fetuses had umbilical artery sampling when the baby was born. Fetuses in study group were additionally evaluated using fetal pulse oximetry. The study showed statistically significant correlation between the fetal pulse oximetry measurements and the umbilical artery pH, PO2, PCO2 and Apgar scores. The sensitivity of fetal pulse oximetry in this study was 77.3%. Its specificity was 95%. Positive predictive value was 89.5% and the negative predictive value was 88.4%. Fetal pulse oximetry is a successful intrapartum monitoring tool to be applied in fetuses with non-assuring fetal heart rate patterns. FPO may help obstetricians in the process of decision making and the use of FPO may help avoid unnecessary cesarean sections performed due to abnormal FHR tracing

Non-invasive predictors of functional capacity in patients with systolic heart failure

Heart failure [HF] is a major health problem facing the population and development all over the world. Selection of patients with heart failure that are at higher risk and in need for more aggressive and interventional modalities in treatment is needed to improve the outcome of HF patients. The functional capacity of HF patients is a good indicator of the patients' clinical status and response to therapy. Therefore, non-invasive predictors of the functional capacity in patients with HF will be useful in determining patients with low functional capacity, worse clinical status and thus at higher risk. 51 patients of either sex, aged 18 years or above attending Suez Canal University Hospital Cardiology outpatient clinic known to have depressed left ventricular [LV] systolic function "Ejection fraction [EF]

Evaluation of interpleural bupivacaine block for postoperative pain relief after major renal surgery

Despite the large positive experience with pleural analgesia after cholecystectomy, only a few studies have evaluated the method for treatment of nephrectomy pain. This study was performed to evaluate the efficacy of pleural analgesia after major renal surgery by evaluating the pain scores, IV opioid requirement and the first time for request for analgesia. 88 patients were randomly assigned to one of two equal groups, group I received loading IV morphine [3mg], half an hour before recovery from anaesthesia, then each patient was connected to the PCA device immediately postoperatively, while the patients in group II an interpleural catheter was inserted by the surgeon under direct vision and 20ml bupivacaine 0.5% was injected half an hour before recovery, followed by 20ml bupivacaine 0.25% every 6 hours. Pain scores [10-cm visual analog scale] and opioid requirements were recorded over the first 24 hours postoperative. Patient characteristics were similar in each group, as was the duration of surgery. The VAS in the interpleural group showed a significant reduction in the pain score half an hour after each interpleural bupivacaine injection with an overall lower pain scores than that of the PCA group both at rest and on coughing. The morphine requirement was significantly less in those given pleural bupivacaine [15 +/- 3mg] than in those given morphine alone [36 +/- 6mg]. Furthermore, the time from completion of surgery until the first opioid request was significantly longer in the patients who received bupivacaine [5.4 +/- 0.6 Vs 2.8 +/- 0.8 h]. We conclude that pleural analgesia significantly prolongs the time until postoperative opioid was first requested and halves the total required dose. These data indicate that pleural analgesia is effective and provides a significant opioid-sparing effect

Prevalence and predictors of renal artery stenosis in patients with coronary artery disease

Chronic renal ischemia caused by atherosclerotic renal artery stenosis [ARAS] is gaining recognition as an important risk factor for cardiovascular morbidity and mortality particularly among patients with coronary artery disease [CAD]. The purpose of this study was to determine the prevalence and to identify the predictors of ARAS in patients with CAD diagnosed by coronary angiography at Suez Canal University Hospital. 65 patients proved to have CAD by coronary angiography were underwent renal arteriography in the same setting. Unilateral RAS [>/= 50% luminal narrowing] was identified in 7 [10.8%] patients and 4 [6.2%] had bilateral RAS. These 11 patients [17%] made up the RAS group. 6 patients of the RAS group had high grade [>/= 70%] renal artery lesions [4 unilateral, and 2 bilateral]. Predictors of ARAS in patients with CAD were: History of peripheral vascular disease [PVD] [p=0.02], higher levels of serum creatinine [p=0.04], presence of left ventricular hypertrophy [LVH] [p=0.03], presence of multivessel CAD [p<0.001]. The number of coronary arteries with stenotic lesions was the most powerful predictor of significant renal artery stenosis. ARAS is prevalent among patients with multivessel CAD [with >/= 3 diseased segments] with even greater prevalence in the presence of PVD, increased serum creatinine level, and concentric LVH

Assessment of autonomic activity in patients with rheumatic mitral stenosis

Mitral stenosis [MS] may increase sympathetic nervous activity by increasing left atrial pressure and decreasing cardiac output. Consequently, increased sympathetic nervous activity may be a risk factor for the development of clinical manifestations and complications of mitral stenosis. Thus, we aimed in this study to assess the sympathetic nervous activity in patients with rheumatic mitral stenosis using heart rate variability analysis and to define factors affecting autonomic function in those patients. The study was conducted upon thirty-one consecutive patients with rheumatic mitral stenosis in sinus rhythm attending cardiology outpatient clinics and another thirty-one normal controls matched for age and gender, and continued from April-2005 until April-2006. Heart rate variability [HRV] analysis was performed in both groups; with full clinical and echocardiographic assessment performed in mitral stenosis patients. Mean N-N interval [Mean NN], standard deviation of all N-N intervals [SDNN], number of N-N intervals that differ by more than 50 milliseconds from adjacent interval divided by the total number of all N-N intervals [PNN50], and high frequency power [HF] were lower; and low frequency power [LF] and low frequency-to-high frequency ratio [LF/HF ratio] were higher in patients with mitral stenosis as compared to their normal counterparts. HRV parameters favoring sympathetic overactivity were found to be significantly correlated to a tighter mitral valve area, higher mean trans-mitral gradient, wider left atrial diameter, higher systolic pulmonary arterial pressure, increased severity of dyspnea and overall duration of patients' symptoms. Thus, sympathetic nervous activity is increased in patients with mitral stenosis and sympathetic overactivity worsens their symptoms. Most significant factors that affect autonomic function in those patients are mitral valve area, mean transmitral gradient, left atrial diameter, and systolic pulmonary arterial pressure

Carcinoma of the anal canal

To evaluate the frequency of anal canal carcinoma in our community, identifying the principle presenting symptoms, associated conditions and our local experience in its treatment. This was a retrospective study on all patients treated at the two major university hospitals and the nuclear medicine centre in Damascus between 1999 and 2004. there were 40 patients, 27 males and 13 females. The average age was 57 [20-70 years]. The patients were divided according to their final pathology into three groups: 1- Squamous cell carcinoma: 18 patients. 2- Adenocarcinoma: 20 patients. 3- Malignant Melanoma: 2 patients. The disease was more common in males than female's 2:1 ratio. Of the associated risk factors noted, smoking was seen in [92%] of the male and [38%] of the female groups respectively. 25% of the males affected were alcoholics. Rectal bleeding and anal pain were the main complaints in the majority of our patients. In the adenocarcinoma group 7 cases were associated with haemorrhoids and 3 cases with fistula-in-ano. In the squamous cell carcinoma group [SCC], two cases were associated with fistula-in-ano and one case with peri-anal abscess. All patients in the adenocarcinoma and melanoma groups were treated surgically by abdominoperineal resection [APR]. Inguinal lymph node dissection was added to all patients with malignant melanoma. In the SCC group, 14 patients were treated successfully with combined chemo-radiation therapy, while 4 patients required surgical treatment and had an APR procedure. Surgeons should include the diagnosis of anal canal carcinoma in cases of persisten anal pain, recurrent haemorrhoids, fistulas and perianal abscesses and direct the investigations towards this including biopsies for histological confirmation. Chemo-radiation should have a primary role in the treatment of patients with SCC preserving surgery for cases of failure of complication of such treatment

Does the addition of nitrous oxide improve sevoflurane induction of anesthesia in children?

Recently, with the introduction of sevoflurane and owing to its ease and speed of induction together with the lack of the pungent irritating odour, all these factors made sevoflurane ideal for inhalation induction in children. Nitrous oxide was known to augment the effect of all inhaled anesthetic agents. The present study tested the hypothesis that N[2]O could facilitate induction and tracheal intubation conditions with 8% sevoflurane in children. The study included 60 children aged 3-10 years divided into 3 groups to undergo inhalation induction with 8% sevoflurane in 50% N[2]O, 66% N[2]O, and 100% oxygen for the three involved groups. Induction time was shortest in group II [66% N[2]O] [46.4 +/- 6.08 s] and longest in group III [100% O[2]] [72. 75 +/- 11.09 s]. Intubation conditions were best in group II with the least complication rate [15%] while group III reported 60% complication rate. Hemodynamically, no clinically important changes were recorded. The study concluded that the use of inhalation induction with 8% sevoflurane in 66% N[2]O was safe in a sense of fast and least eventful induction with easy and favourable intubating conditions in children undergoing elective surgery

Ocular manifestations in patients with systemic lupus erythematosus: prevalence and relation to disease activity

This study aimed to investigate spectrum of ocular manifestations in systemic lupus erythematosus [SLE] patients and to clarify their relation to disease activity. Seventy female patients fulfilling the American College of Rheumatology [ACR] criteria for the diagnosis of SLE were enrolled in this study. Full medical history was taken with comprehensive clinical examination performed in all patients. Rheumatological laboratory investigations were done. Disease activity was assessed using Systemic Lupus Activity Measure [SLAM] index. Full ophthalmic examination was done including assessment of the lacrimal function and fundus examination. Fundus photography and fluorescein angiography were done for patients with evident or suspected posterior segment manifestations. From the results obtained, it was concluded that ocular manifestations are common with SLE. Although most ocular affection in SLE is relatively benign, sight-threatening complications are not rare. Visual compromise is usually related to retinal or optic nerve involvement and both are strongly correlated with the systemic disease activity. Therefore, early recognition of SLE ophthalmic manifestations and timely institution of systemic therapy may minimize visual morbidity. In a similar vein, documented SLE eye affection may guide the rheumatologist to either disease reactivation or systemic drug-related complications