Aetiologies of Liver Cirrhosis among Adult Patients Attending A Hepatology Clinic at Selangor, Malaysia

Introduction @#Liver cirrhosis is an important cause of morbidity and mortality. @*Methods@#Our study aimed to describe the clinical pattern of cirrhosis and its associated factors among adult patients attending Hepatology Clinic, Serdang Hospital, Malaysia from 1st January 2010 to 30th June 2017. Aetiology was further determined by history, biochemistry and/or histology. The severity of the cirrhosis, together with the presence of complications and incidence of hepatocellular carcinoma were documented.@*Results@#A total of 357 adult patients were diagnosed with cirrhosis including 199 male patients (55.7%) and 158 female patients (44.3%), with a mean age of 54-year-old (range: 28-84 year-old). The causes of cirrhosis were chronic hepatitis B (N=145, 40.6%), chronic hepatitis C (N= 67, 18.8%), cryptogenic liver disorder (N= 63, 17.6%), alcohol (N=42, 11.8%), non-alcoholic fatty liver disease (N=25, 7.0%), and others (N=15, 4.2%). Chronic hepatitis B was the predominant aetiology among Chinese whereas alcohol was the main aetiology among Indians, and Hepatitis C cirrhosis was highest among Malays. Majority of the patients had compensated cirrhosis with Child-Pugh A (N=221, 61.9%) at the time of diagnosis. 80.4% (N=287) of the cirrhotic patients had performed at least one endoscopy surveillance, with 28.6% (82/287) of them had endoscopic evidence of portal hypertension. 32.2% of patients had at least one hospitalization due to complication of cirrhosis. 41 patients (11.5%) had concurrent hepatocellular carcinoma during the follow up. @*Conclusions@#Despite universal hepatitis B vaccination, Hepatitis B viral infection remains the most common cause of cirrhosis among patients attending Hepatology Clinic, Serdang Hospital.

The current understanding of the interactions between nanoparticles and cytochrome P450 enzymes - a literature-based review.

Nanoparticles (NPs) have wide spectrum applications in the areas of industry and biomedicine. However, concerns about their toxic and negative impacts on the environments as well as human health have been raised. Cytochrome P450s (CYPs) are involved in endogenous and exogenous metabolism. Modulations of CYP can adversely damage drug metabolism, detoxification of xenobiotics and animal physiology functions. This article focused on NPs-CYP interactions for humans and animals available in the literature. It was found that different NPs process specific inhibitory potencies against CYPs involved in drug metabolism. Moreover, NPs were able to modify the expression of CYPs genes or protein in humans and other animals, which highlighted their detoxification functions. Nonetheless, changes of CYPs responsible for hormone synthesis and metabolism resulted in endocrine disturbances. Hence, there is a need to screen newly developed NPs to evaluate their interactions with CYPs. The future studies should further strategize the in vitro approaches to reveal the molecular mechanisms behind interactions by taking full considerations of the interference of co-factors, buffers, substrates and metabolites with NPs. Moreover, in vivo studies should compare the influences of NPs via different administration routes and different duration of treatments to reveal the physiological significance.

Detection rate of colonic polyp among patients who had undergone colonoscopy at gastroenterology unit of Serdang Hospital, Malaysia

@#The aim of this study was to evaluate the demography, and to determine the detection rate of polyps, and detection rate of adenoma at a Malaysian tertiary hospital.

Effects of Synbiotics among Constipated Adults in Serdang, Selangor, Malaysia-A Randomised, Double-Blind, Placebo-Controlled Trial.

Synbiotics approach complementarily and synergistically toward the balance of gastrointestinal microbiota and improvement in bowel functions. A randomised, double-blind, placebo-controlled study was conducted to examine the effects of a synbiotics supplement among constipated adults. A total of 85 constipated adults, diagnosed by Rome III criteria for functional constipation were randomised to receive either synbiotics (n = 43) or placebo (n = 42) once daily (2.5 g) in the morning for 12 weeks. Eight times of follow-up was conducted every fortnightly with treatment response based on a questionnaire that included a record of evacuation (stool frequency, stool type according to Bristol Stool Form Scale), Patients Assessment on Constipation Symptoms (PAC-SYM), and Patients Assessment on Constipation Quality of Life (PAC-QOL). There were no significant differences in stool evacuation, but defecation frequency and stool type in treatment group were improved tremendously than in placebo group. While the treatment group was reported to have higher reduction in severity of functional constipation symptoms, the differences were not statistically significant. Dietary supplementation of synbiotics in this study suggested that the combination of probiotics and prebiotics improved the functional constipation symptoms and quality of life although not significant. This was due to the high placebo effect which synbiotics failed to demonstrate benefit over the controls.

Assessment of the level of knowledge of colorectal cancer among public at outpatient clinics in Serdang Hospital: a survey based study

Objectives: Colorectal cancer (CRC) is one of the mostcommon gastrointestinal cancers in the world. In the AsiaPacificregion, it is the fastest emerging gastrointestinalcancer. Level of awareness on CRC warning signs and riskfactors in the rural population of Malaysia is reported of verylow. The aim of this study was to assess the level ofknowledge of CRC among the public at medical outpatientclinics in Serdang Hospital. The association between sociodemographicfactors with level of knowledge among therespondents was further studied.Study design: A study was conducted among the non-CRCpatients’ relatives accompanying their relatives to themedical outpatient clinics in Serdang Hospital from 1st Aprilto 31st August 2016. The study was carried out with clustersampling method.Methods: The respondents were assessed using validatedand modified Cancer Awareness Measures (CAM)questionnaire consists of three parts which are knowledgeon warning signs, knowledge on risk factors and sociodemographicfactors. All data were analysed using IBMSPSS Statistics 21.0.Results: Altogether 308 subjects completed thequestionnaires. It was shown high percentage of goodknowledge for warning signs and risk factors of CRC amongthe respondents. A significant association between agegroups and level of income with level of knowledge onwarning signs was observed.Conclusions: The level of knowledge of CRC among thegeneral public in Serdang Hospital was sufficient. Therespondents with higher income or younger age had higherlevel of knowledge regarding CRC.

The Prevalence and Symptoms Characteristic of Functional Constipation Using Rome III Diagnostic Criteria among Tertiary Education Students.

BACKGROUND AND AIMS: Functional constipation is very common with heterogeneous symptoms that have substantial impact on patient quality of life as well as medical resources which are rarely reported as life-threatening. The aim of this study is to examine the prevalence and symptoms characteristic of functional constipation (FC) by using Rome III diagnostic criteria among tertiary education students with an intention to introduce treatment in the future. METHODS: Demographic, socio-economics characteristics and symptoms of FC using the Rome III criteria were sought using a questionnaire administered to Malaysian students in a tertiary education setting. Other data obtained were the general health status, lifestyle factors and anthropometric measurements. Using a simple random sampling method, a total of 1662 students were recruited in the study with a response rate of 95.0%. Sampled data are presented as frequency and percentage and stratified accordingly into categories for Chi-square analysis. RESULTS: The prevalence of functional constipation among the students was 16.2%, with a significantly higher prevalence among women (17.4%) than men (12.5%). Hard or lumpy stool, incomplete evacuation, anorectal obstruction and straining were reported as the commonest symptoms experienced. Type 3 was the most frequent stool consistency experienced among the constipated individuals (35.2%). Only 4.4% of individuals reported having less than three defecations per week. Using univariable analysis, FC was significantly associated with sex (odds ratio: 1.48, 95% CI: 1.06-2.06) and age group (odds ratio: 1.34, 95% CI: 1.01-1.79) with P value < 0.05 significance level. In multivariate logistic regression analysis, only sex was found significantly associated with FC (adjusted odds ratio: 1.53, 95% CI: 1.08-2.17, P < 0.05). CONCLUSIONS: Based on the prevalence rate, constipation is a common problem among tertiary education students (16.2%), with significantly more prevalence among the female respondents. Early detection of symptoms and further intervention studies focusing on treatment recommendation in improving the symptoms are essential.

Prevalence of Helicobacter Pylori Infection among Patients Attending Gastroenterology Endoscopy Unit at Serdang Hospital

To study the prevalence of Helicobacter Pylori (H. pylori) infection, according to ethnicity, gender and endoscopic findings among the patients underwent the oesophago-gastro-duodenoscopes (OGDS) at gastroenterology endoscopy unit, Hospital Serdang, Selangor, Malaysia. The database of all whom underwent OGDS at the gastroenterology endoscopy unit, Hospital Serdang from 1st August 2010 to 31st July 2012 was collected and assessed, retrospectively. A total of 924 patients who underwent OGDS were analyzed for the H. pylori infection by using Campylobacter-like organism (CLO) test. 130 (14.07%) tested positive, and their data were further studied according to gender, ethnicity, age group, initial indication for OGDS and endoscopic finding. The prevalence rate among males was 15.15% (70/462), while it was 12.99% (60/462) among females. In terms of ethnics, H. pylori infection was commonly found among Indian and Chinese with prevalence rate of 25.13% (50/199) and 17.41% (51/293) respectively. These figures are significantly higher than the 6.01% (25/416) for Malays. The age group (31-50 years old) had the highest prevalence rate of H. Pylori infection, which is of 18.55% (41/221). No significant difference was observed among initial indications for OGDS. Erosions were the commonest finding in H. pylori positive group with rate of 51.54% (67/130). However, erosions were not uncommon in H. pylori negative group as well with the rate of 48.61% (386/794). H. pylori infection rate among Malaysians was generally low, with the highest rate in Indians, followed by Chinese and relatively low in Malays. No significant difference between the prevalence rate of H. pylori infection in male and that in female was found. Erosions were equally common in either H. pylori positive or H. pylori negative group. .