Multidiscipline Care for Type 2 Diabetes Patients: from General to Asian Population.

Multidiscipline care is defined as a care consisting of at least a physician, a nurse, and other healthcare worker (eg. dietician). Multidiscipline care has generated benefits, both in medical aspects (eg. increasing patients' compliance) and nonmedical aspects (eg. more cost-effective than conventional treatment). There are several models of multidiscpline care; however, which model is more suitable for type 2 diabetes care is not clear yet. In this review, we aimed to identify and compare multidiscipline care method for reducing glycated hemoglobin ( HbA1C) levels in type 2 diabetes patients, particularly Asian patients because they have greater tendency to develop type 2 diabetes at lower degrees of obesity and at younger ages than Caucasian ethnic group. There were limited number of studies examining multidiscipline care for type 2 diabetes patients, moreover for Asian patients. They showed mixed results on the efficacy of multidiscipline care in achieving HbA1C target. Healthcare personnel visit, either personal or group session, appeared effective both for general and Asian T2DM patients. It needs further studies to clarify which models are most effective for practices of varying cultures, socio-economic condition, and healthcare settings.

Efficacy of Curcumin as Adjuvant Therapy to Induce or Maintain Remission in Ulcerative Colitis Patients: an Evidence-based Clinical Review.

BACKGROUND: treatment guidelines for ulcerative colitis (UC) not yet established. Currently, mesalazine, corticosteroids, and immunomodulators are treatment options for UC. However, they are known to have unpleaseant side effects such as nausea, vomiting, headaches, hepatitis, and male infertility. Curcumin is found in Turmeric plants (Curcuma longa L.), which possesses both anti-inflammatory and antioxidant properties. This study aimed to determine whether curcumin as adjuvant therapy can induce or maintain remission in UC patients. METHODS: structured search in three database (Cochrane, PubMed, Proquest) using "Curcumin", "remission" and "Ulcerative Colitis" as keywords. Inclusion criteria is randomized controlled trials (RCTs), meta-analysis, or systematic review using curcumin as adjuvant therapy in adult UC patients. RESULTS: we found 49 articles. After exclusion, three RCTs were reviewed; two examined curcumin efficacy to induce remission and one for remision maintenance in UC. Curcumin was significantly more effective than placebo in all RCTs. The efficacy of curcumin could be explained by its anti-inflammatory properties, which inhibit NF-kB pathway. Regulation of oxidant/anti-oxidant balance can modify the release of cytokines. However, methods varied between RCTs. Therefore, they cannot be compared objectively. Futhermore, the sample size were small (n= 50, 45, 89) therefore the statistical power was not enough to generate representative results in all UC patients. CONCLUSION: Available evidence showed that curcumin has the potential to induce and maintain remission in UC patients with no serious side effects. However, further studies with larger sample size are needed to recommend it as adjuvant therapy of ulcerative colitis.

Large apical lung cancer treated with CT-guided percutaneous cryoablation.

Percutaneous lung ablation is increasingly used in the treatment of lung malignancies with good outcomes, but recurrence is commonly reported in ablation of lesions size larger than 3 cm. We report a 50-year-old female with a 9 cm nonsmall cell lung cancer involving the right upper lobe and apical chest wall causing severe neuropathic shoulder pain and significantly disturbing her daily activities. CT-guided percutaneous cryoablation was performed using a 4-phase protocol with complete eradication of the tumor. Follow-up imaging showed no evidence of recurrence 6 months after the procedure. The neuropathic pain was significantly improved after the procedure, and she was pain-free until her death due to metastatic disease elsewhere. To our knowledge, this is the first case of successful cryoablation for an exceptionally large lesion.

Multiple myocardial bridging in the elderly: A rare case.

Myocardial bridging occurs when a segment of major epicardial coronary artery courses intramurally through myocardium, commonly involving the left anterior descending. However, myocardial bridging involving coronary arteries other than left anterior descending is less-common and rarely reported, especially in the elderly population. We report a rare case of multiple myocardial bridging involving the left anterior descending, first obtuse marginal, and ramus intermedius in a 68-year-old Asian female. We also briefly discuss the imaging evaluation and pathophysiology of myocardial ischemia in myocardial bridging. This is the second reported case of myocardial bridging involving such combination, and to our knowledge, the first for elderly patient.

Pediatric acute lymphoblastic leukemia and leukapheresis: CT evidence of hemorrhagic complication.

Leukapheresis has been used widely to quickly reduce white blood cell count (WBC) in patients with hyperleukocytosis. Despite its wide utilization, leukapheresis has risks of complication, which have not been thoroughly reported in pediatric patients. No report was found in English literatures about leukapheresis complications in children with acute lymphoblastic leukemia (ALL). We reported a 4-year-old girl with ALL and hyperleukocytosis, with no sign of bleeding. After leukapheresis, WBC and platelet count decreased, and patient complained of headache. Neurological deficit developed quickly afterwards. Intracranial infection was suspected clinically. Contrast-enhanced head CT revealed multiple hyperdense lesions and diffuse cerebral oedema. The patient was subsequently diagnosed with multiple intraparenchymal hemorrhage, and leukapheresis was stopped. Intracranial hyperdense lesion in leukemic patients has many differential diagnosis, such as infection, granulocytic sarcoma (chloroma), and hemorrhage. Lesion characteristics in CT could help point the diagnosis. History of leukapheresis should also raise suspicion of hemorrhage. This article discussed CT characteristics of multiple brain hemorrhage in pediatric ALL after leukapheresis and how to differentiate it with other common intracranial complications of leukemia.