Malaysian joint societies' consensus recommendations on diagnosis and management of disorders of esophagogastric junction outflow.

Disorders of esophagogastric junction (EGJ) outflow, including achalasia and EGJ outflow obstruction, are motility disorders characterized by inadequate relaxation of lower esophageal sphincter with or without impaired esophageal peristalsis. Current guidelines are technical and less practical in the Asia-Pacific region, and there are still massive challenges in timely diagnosis and managing these disorders effectively. Therefore, a Malaysian joint societies' task force has developed a consensus on disorders of EGJ outflow based on the latest evidence, while taking into consideration the practical relevance of local and regional context and resources. Twenty-one statements were established after a series of meetings and extensive review of literatures. The Delphi method was used in the consensus voting process. This consensus focuses on the definition, diagnostic investigations, the aims of treatment outcome, non-surgical or surgical treatment options, management of treatment failure or relapse, and the management of complications. This consensus advocates the use of high-resolution esophageal manometry for diagnosis of disorders of EGJ outflow. Myotomy, via either endoscopy or laparoscopy, is the preferred treatment option, while pneumatic dilatation can serve as a secondary option. Evaluation and management of complications including post-procedural reflux and cancer surveillance are recommended.

Complementary alternative medicine use among patients with dengue fever in the hospital setting: a cross-sectional study in Malaysia.

BACKGROUND: In Malaysia, the number of reported cases of dengue fever demonstrates an increasing trend. Since dengue fever has no vaccine or antiviral treatment available, it has become a burden. Complementary and alternative medicine (CAM) has become one of the good alternatives to treat the patients with dengue fever. There is limited study on the use of CAM among patients with dengue fever, particularly in hospital settings. This study aims to determine the prevalence, types, reasons, expenditure, and resource of information on CAM use among patients with dengue fever. METHODS: This is a descriptive, cross-sectional study of 306 patients with dengue fever, which was carried out at the dengue clinic of three hospitals. Data were analysed using IBM SPSS Statistics version 21.0 and logistic regression analysis was used to determine the factors associated with CAM use. RESULTS: The prevalence of CAM use was 85.3% among patients with dengue fever. The most popular CAMs were isotonic drinks (85.8%), crab soup (46.7%) and papaya leaf extract (22.2%). The most common reason for CAM use was a good impression of CAM from other CAM users (33.3%). The main resource of information on CAM use among patients with dengue fever was family (54.8%). In multiple logistic regression analysis, dengue fever patients with a tertiary level are more likely to use CAM 5.8 (95% confidence interval (CI 1.62-20.45) and 3.8 (95% CI 1.12-12.93) times than secondary level and primary and below respectively. CONCLUSION: CAM was commonly used by patients with dengue fever. The predictor of CAM use was a higher level of education.

Mixed Neuroendocrine - Nonneuroendocrine Neoplasm Arising in Barrett's Esophagus.

Barrett's esophagus, which results from chronic gastroesophageal reflux disease, is a known precursor to dysplasia and ultimately esophageal adenocarcinoma. Mixed neuroendocrine - nonneuroendocrine neoplasm (MiNEN) is a rare and heterogenous group of neoplasm with aggressive clinical behavior in general. There have been rare reports of MiNEN arising in Barrett's esophagus, and its pathogenesis remains unclear. Surgical resection with lymph node dissection remains the most effective treatment of MiNEN of the esophagus to date, although the evidence on its optimal treatment is scant. How to cite this article: Lee SL, Ng CY, Gew LT, et al. Mixed Neuroendocrine - Nonneuroendocrine Neoplasm Arising in Barrett's Esophagus. Euroasian J Hepato-Gastroenterol 2022;12(1):57-59.

A case of immune thrombocytopenic purpura with prolonged aPTT time: A clotter hidden in a bleeder?

We report the case of a 23-year-old woman who presentedwith prolonged menstruation and multiple bruises on thelimbs and trunk. Investigations revealed severethrombocytopenia and deranged coagulation profile withmarkedly prolonged activated partial thromboplastin time(aPTT). Lupus anticoagulant, anti-cardiolipin antibody andanti-beta-2-glycoprotein 1 antibody were positive. She wasdiagnosed with Immune Thrombocytopenic Purpura (ITP)with positive antiphospholipid antibody serology and givena course of intravenous methylprednisolone and taperingdoses of oral prednisolone. She was steroid free and had nobleeding or thrombotic event over two years follow up.