Roles of Capsule Endoscopy and Balloon-Assisted Enteroscopy in the Optimal Management of Small Bowel Bleeding

The small bowel had long been considered a dark unapproachable tunnel until the invention of capsule endoscopy and doubleballoon enteroscopy in the 21st century, which revolutionized the diagnosis and management of small bowel diseases, including bleeding. Various imaging modalities such as computed tomographic enterography, angiography, capsule endoscopy, and balloonassisted enteroscopy play vital roles in the diagnosis and management of small bowel bleeding. The choice of modality to use and timing of application differ according to the availability of the modalities, patient’s history, and physician’s experience. Small bowel bleeding is managed using different strategies as exemplified by medical treatment, interventional radiology, endoscopic therapy, or surgical intervention. Balloon-assisted enteroscopy enables endoscopic interventions to control small bowel bleeding, including electrocautery, argon plasma coagulation, clip application, and tattooing as a prelude to surgery. In this article, we clarify the recent approaches to the optimal diagnosis and management of patients with small bowel bleeding.

Development of Skala Kepuasan Kaunseling Mandatori

@#Introduction: Mandated counselling is usually associated with forced participation. Therefore, there is considerably higher likelihood of involuntary participation resulting in client’s dissatisfaction toward the counselling session. However, there exists literature that shows satisfaction and positive outcomes among mandated clients. Mandated counselling is widely practised, especially in the case of Malaysia. Thus, an instrument to measure client’s satisfaction was developed to capture the client’s perception, attitude and factors that contributed to the mandated counselling satisfaction. Methods: The respondents involved in this study were adolescents in rehabilitation centres under the supervision of the Department of Social Welfare (Jabatan Kebajikan Masyarakat) aged 13 to 19 who had attended mandated counselling at least twice. The study was divided into four phases. Initially, in the first phase, the items were developed based on themes narrated by mandated clients and from the counsellor’s perspectives. Next, the initial measurement developed was tested to identify dimensions conceptualized in the instrument. Then, the reliability of the instrument was tested. In the final phase, a confirmatory factor analysis was conducted to confirm the model. Results: Findings showed a 52% of total variance was explained in the exploratory factor analysis, with an internal consistency of .919. The findings also showed a 16-item measurement with four dimensions: (a) alliance-system; (b) counselling efficacy; (c) therapeutic change; (d) counsellor-counselling effect. Conclusion: : In summary, this study had identified significant factors essential in influencing satisfaction of mandated counselling clients in the Malaysian context. It is thus beneficial for counselling practitioners in their counselling work involving mandated clients.

Evaluation of upper right abdominal pain in patients of dengue fever

Objective: To Evaluate patients with upper Right abdominal pain in dengue fever

Study Design: Prospective descriptive study

Place and Duration of the Study: This study was conducted at Mamji Hospital Karachi between August 2012 to October 2014

Materials and Methods: The patients presented with confirmed dengue fever with upper right abdominal pain. The study was conducted in Mamji Hospital F.B area. The data was gathered and analysed on SPSS version 15

Results: Total cases were 113.Males were 62 [55%] and 51[45%] were females. The mean age was 27 +/- 9. With the range from 18 to 36 years. Males were slightly more than females. The causes of abdominal pain were acalculuscholicystitis in 57 cases[50%], hepatitis in 17 cases[15%], pancreatitis in 5 cases[4.4%] and no cause was detected in 34 cases[30%].Total leukocyte count was not high and thrombocytes were low in every case. SGPT was mildly[Less than 100]raised in 71 cases [63%], moderately raise [more than 200] in 27 cases [23%] and severely raised in 12 cases [10.6%][more than300] and in 03 cases [3%] the SGPT was normal. Ultrasound finding of acute acalculus cholecystitis were enlarged gallbladder with thickened wall in 57 cases [50%] while 9 cases [8%] had gall stones without inflammatory signs. Perihepatic fluid in 35 cases [31%]. Swollen pancreas were noted in 5 cases [4.4%].Amylase were raised in 13 cases [11.5%] and serum lipase were raised in 5 cases [4.6%]

Conclusion: The acalculuscholecyctitis is one of the commonest cause of upper abdominal pain in denguefever. It is also consider as an early sign of severeinfection

HCV core antigen testing versus HCV PCR testing for early detection of HCV infection

HCV core antigen is detectable in serum several weeks earlier than anti-HCV antibodies. Variability in early detection time is even more pronounced in certain groups of patients such as the hemodialysis and immunocompromised where the antibody response may take between 45-68 days to develop. Early detection of HCV core Ag in serum may represent an attractive, cost effective screening tool for such high risk patients. The current study aimed at evaluation of the analytical performance of the Abbott Architect HCV Chemiluminescenat Microparticle Immunoassay [CMIA] in comparison to the standard PCR detection of HCV RNA. In addition, the current study evaluated the possible clinical utility of HCV Ag kit in testing pooled samples from several patients. Samples from 44 HCV patients and 15 controls were analyzed using the CMIA HCV core Ag assay and quantitative PCR. Samples from positive HCV patients were pooled and analyzed using the HCV core Ag assay. The current study demonstrated a sensitivity of 81.0% and specificity of 97.0% for the ABBOTT HCV core Ag kit assay in detecting HCV positive cases compared to quantitative PCR assay. The most important finding of the current study is that HCV core Ag assays may have false negative results at low level viremia [low HCV copy numbers]. The current study does not support using HCV core Ag as a single test for screening possible HCV cases or using HCV core Ag assays on pooled samples. Bigger studies may be needed to strengthen the findings of the current study

Evaluation of attitudes of the community pharmacists toward warfarin interactions

The major objectives of this study was to evaluate the attitudes of community pharmacists drug nutrient [warfarin-food containing vitamin K] and drug -drug interactions [warfarin-vitamin K]. The data were collected through three scenarios by the researcher as a co-patient from a total of 90 practicing pharmacists in community pharmacies in Khartoum State during February to April 2011. Only 7% in Omdurman city, 10% in Bahry and Khartoum cities had knowledge about food containing vitamin K. The ratios ranged from 7%-13%. The discussion showed that since the majority of pharmacists surveyed demonstrated lack of knowledge about drug-nutrient interaction, inadequate knowledge may lead to inappropriate patient counseling and adverse medical consequences. Additional training and integration of knowledge and expertise about drug-nutrient interactions among healthcare professionals is essential to provide appropriate patient counseling and optimal therapeutic outcomes

Oral candidal carriage in young insulin dependent diabetics.

Fifty patients with insulin-dependent diabetes mellitus (IDDM) in the age group of 5-20 years were assessed for oral candidal carriage state and other related oral manifestations. The control group showed 16% Candida carrier state, whereas the IDDM group showed 92% candida carrier state. The candidal count was significantly higher in the IDDM group. Other associated oral manifestations like dry mouth, burning sensation, and painful fissures were also observed in the IDDM subjects.