Conventional surgery in colon cancer with comparison to complete mesocolic excision and central vascular ligation: initial experience in a tertiary centre.

INTRODUCTION: The complete mesocolic excision (CME) and central vascular ligation (CVL) is an advanced surgical technique used to treat colon cancer. It combines the removal of the affected portion of the colon and surrounding lymph nodes with an improved method of controlling the vascular supply to the tumour. MATERIALS AND METHODS: A retrospective study of patients with colon cancer underwent right hemicolectomy (either CME and CVL or conventional method) were operated by colorectal surgeons in a tertiary centre in Kuala Lumpur from 2018 to 2020. We review the data to compare the oncological, pathological and surgical outcomes of both techniques. Categorical variables were presented as frequencies and percentages. Continuous variables were compared using an independent t-test or Mann-Whitney Rank U test. The chi-square test was used to determine the association between categorical variables and mortality. Statistical analysis was conducted with IBM SPSS Statistics 25.0, and statistical significance was set at p<0.05. RESULTS: A total of 30 patients (CME and CVL=15 or conventional colectomies=15) were included in this study with mean age of 65 years. There was no statistical difference between the mean age of the two groups (p=0.355). Most of the patients were Malays (46.7%) followed by Chinese (43.3 %) and Indians (10.0%). The mean (SD) = 19 (9) number of lymph nodes harvested is more in CME and CVL groups which however is not statistically significant compared to the mean (SD) = 16 (9), number of lymph nodes in conventional colectomies. The duration of surgery is longer in CME and CVL groups (214 minutes) compared to conventional colectomies (188 minutes) but with no significant statistical difference. Most of the perioperative complications were similar in both groups with no significant statistical differences. CONCLUSION: CME and CVL are not inferior to conventional surgery in colon surgery in a tertiary centre. It should be considered since the advantages such as lymph node yield and median recurrence free survival are better with similar perioperative morbidity.

Evaluating factors associated with paediatric cochlear implant outcome in four cochlear implant satellite centres in Malaysia.

INTRODUCTION: Many factors are associated with cochlear implant (CI) outcomes and various methods of assessment for auditory and speech performance outcomes in CI are available globally. The objective of this study is to identify factors relating to CI outcomes in paediatric population that suits local context. MATERIALS AND METHODS: A total of 18 factors consisted of variables which emphasise on audiological, CI service team, speech therapy, and family-related factors. These factors were then retrospectively analyzed among CI recipients. The outcome measurements of categorical auditory performance II (CAP-II) and speech intelligibility rating (SIR) were used to individually study each factor. Kruskal-Wallis H Test and Fisher Exact Test used with p-value <0.05 were considered significant. RESULTS: There were significant associations between post- CI CAP-II with type of hearing loss, hearing aid usage per day and mode of communication, attention, attending audiology and speech session, and siblings. For post-CI SIR, hearing aid usage per day, attention, mode of communication, attending audiology and speech session, initiatives, and siblings were statistically significant. CONCLUSION: The factors affecting the outcome of CI are dynamic. Some of the factors have demonstrated to be associated with the auditory and speech outcome in CI recipients while some factors failed to replicate similar findings. Further prospective research may refine the outcome of individual factors.

Combination of hysteroscopic resection of endomyometrium with insertion of Mirena: An alternative treatment for adenomyosis.

Adenomyosis is a common gynaecological condition encountered in clinical practice. Treatment of adenomyosis can present a great challenge to gynaecologists as women often become resistant to hormonal treatment eventually needing surgical intervention. Hysterectomy has long been the definitive treatment for adenomyosis. However, with women currently being diagnosed at an earlier age and still have not completed their family, there is an increasing demand for effective intervention with uterine conservation. We report here two cases of patients who had undergone a combination of hysteroscopic resection of the endomyometrium combined with Mirena insertion with successful outcome.

Imported Falciparum Malaria: A case series in a tertiary hospital.

INTRODUCTION: Malaysia declared its intent to eliminate malaria by 2020, with a phased goal of achieving zero local transmission. Nonetheless, Malaysia is highl susceptible to malaria importation due to geographical proximity to high-burden countries e.g. Thailand, Myanmar and high influx of foreign workers and students from Asia and Africa. CASE SERIES: We accumulated all malaria cases diagnosed in a tertiary hospital within a period of two years. Three cases were reported, where all of the patients were foreigners with recent travel history to African countries. All of them were infected by P. falciparum, responded to treatment and discharged well. DISCUSSION: This case series highlighted the importance of acquiring recent travel history during history taking and having a high index of suspicions on malaria when dealing with feverish patients originated particularly from African countries.

Carbapenem-Resistant Enterobactericeae: ClinicoEpidemiological Perspective.

Since its first discovery in 1996, Carbapenem-resistant Enterobactericeae (CRE) has been increasingly reported as a cause of infections particularly in immunocompromised patients. With limited treatment options, these multidrug-resistant organisms are associated with high mortality rates and are now recognized as an important cause of health-care associated infections. This study aimed to determine the prevalence of CRE at a 500-bedded tertiary hospital in Selangor, Malaysia. This study identified and analyzed CRE culture results from January 2015 to December 2016. The isolates were identified by conventional and Vitek 2® methods. Susceptibility tests were done by disk diffusion technique and confirmed by E-test. Polymerase chain reaction was performed to identify NDM-1, KPC, OXA-48, VIM and IMP genes. Demographic data and clinical characteristics were collected from the Hospital Information System. The prevalence of CRE in 2015 and 2016 was 0.3% (5/1590) and 1.2% (17/1402) respectively. 65% of the patients had underlying haematological disorders. Majority (81.8%) of the isolates were Klebsiella pneumoniae, followed by Serratia marcescens, Escherichia coli, and Citrobacter koseri. Klebsiella pneumoniae that co-produced NDM-1 and OXA48 genes were the most common encounter (41%), followed by OXA-48 (35%), NDM-1 (12%) and KPC (6%). All isolates were resistant to all generations of cephalosporin and carbapenem. The rate of resistance to tigecycline, polymyxin B and colistin were quite high; 46% (5 from 12 isolates), 17% (2/12) and 17% (3/17) respectively. The prevalence of CRE in this institution was relatively low. However, there is a high prevalence of OXA-48 and NDM co-producer amongst CRE isolates. Physicians should have high index of CRE suspicion in hematological patients.

Erysipelas of the upper extremity following locoregional therapy for breast cancer.

Cellulitis is a well-known complication of lymphedema of the lower extremities. Erysipelas of the upper extremity complicating breast cancer therapy has never been reported in the English-language literature. We describe seven breast cancer patients with erysipelas of the upper extremity. Five had a predisposing injury to the extremity. All patients responded very well to intravenous antibiotics without any sequelae. They had rapid resolution with typical desquamation. No long-term sequelae were seen except for mild increase of lymphedema. Erysipelas should be listed as a rare complication after locoregional therapy for breast cancer. Intravenous penicillin should be used as the initial therapy. Prevention of arm lymphedema and avoidance of any trauma to the arm are important prophylactic measures. Sentinel lymph node biopsy reduces the rate of axillary lymph node dissection and thus should reduce the incidence of lymphedema and erysipelas.

Incidence of urinary tract infection following transrectal ultrasound guided prostate biopsy at a tertiary-care medical center in Lebanon.

OBJECTIVE: To determine the incidence of urinary tract infections (UTIs) following transrectal ultrasound guided needle biopsy of the prostate (TRUBP) and the bacteriology of these infections. DESIGN: Retrospective evaluation of the charts and records of all patients who underwent TRUBP between June 1, 2002, and August 31, 2003. SETTING: American University of Beirut Medical Center, a tertiary-care center in Lebanon. PATIENTS: Two hundred seven patients underwent TRUBP. All received prophylactic antibiotics. One hundred twenty (58%) received ciprofloxacin alone, whereas 87 (42%) received both ciprofloxacin and gentamicin. Sixty-one patients (29.5%) had an enema prior to the procedure, whereas 146 (70.5%) did not. RESULTS: Thirteen patients (6.3%) were admitted with UTI. All had rigors and fever on admission. Symptoms appeared at a mean of 2.7 days and the mean hospital stay was 9.2 days. The mean duration of antibiotic treatment was 23.2 days. Ten (77%) of the patients had positive bacteriology. Urine cultures were positive in 8 (61.5%) of the patients and blood cultures in 6 (46.2%). All positive cultures grew Escherichia coli resistant to ciprofloxacin, with 5 isolates producing extended-spectrum betalactamases. CONCLUSIONS: TRUBP continues to be associated with significant infectious complications, especially UTI. Given the increasing incidence of antibiotic resistance mainly among the Enterobacteriaceae, antimicrobial prophylaxis practices should be reevaluated and the universal administration of quinolones alone or in combination with aminoglycosides should be reconsidered.

Cytology of Ki-1-positive anaplastic large cell lymphoma. A report of two cases.

BACKGROUND: Ki-1-positive anaplastic large cell lymphoma (Ki-1 ALCL), one of the more recently described pleomorphic types of lymphoma, affects mostly children and adolescents and is sometimes mistaken for carcinoma or sarcoma. CASES: Two cases of Ki-1 ALCL were diagnosed on cytology. One patient presented with generalized lymph-adenopathy and involvement of the skin and subcutis, while the other was admitted with pneumonia and multiple subcutaneous masses in the chest wall. Fine needle aspiration cytology smears in both cases showed dissociated cells with abundant, lightly basophilic, vacuolated cytoplasm; oval, round or lobulated nuclei; and binucleate, trinucleate and multinucleate cells with a wreathlike arrangement of nuclei. Most of the tumor cells expressed immunocytologic reactivity to CD 30, and a cytologic diagnosis of Ki-1 ALCL was made. Tru-cut biopsy of the chest wall tumor in case 2 and review of lymph node biopsy done one year previously in case 1 permitted a cytohistologic correlation. CONCLUSION: Knowledge of the distinctive cytomorphologic features of Ki-1 ALCL combined with the clinical setting should enable its distinction from other pleomorphic neoplasms in most cases, while in others it should go a long way toward narrowing the cytologic differential diagnosis.

Rhabdomyolysis and Salmonella typhi infection: case report and review of the literature.

Typhoid fever is endemic in Lebanon. Usual presentation includes fever, headache, abdominal pain and constipation or diarrhea. Extra-intestinal manifestations are not uncommon and involve variety of organ systems. Rhabdomyolysis is rare and has been reported in various Salmonella infections. We present a case of rhabdomyolysis and renal failure that was successfully treated with imipenem/cilastatin and hemodialysis.

Gigantism of the lower limb in Klippel-Trenaunay syndrome: anatomy of the lateral marginal vein.

The Klippel-Trenaunay syndrome is a combination of venous and capillary malformations associated with soft tissue and/or bony limb hypertrophy, with or without lymphatic malformations. Although persistent foetal veins are rare, the persistence of the lateral marginal vein is a common association in this syndrome. It results in venous hypertension, which gives rise to venous varicosities, which are commonly seen in this syndrome. This is a case report of a 28-year-old man with Klippel-Trenaunay syndrome, with persistence of the lateral marginal vein, affecting his right lower limb. He was treated with an above-knee amputation. The amputated limb was dissected to demonstrate the anatomy of the lateral marginal vein. To the best of the authors' knowledge, the gross anatomy of the lateral marginal vein has not been previously reported.

Health care workers' exposure to blood-borne pathogens in Lebanon.

BACKGROUND: Accidental exposure to blood-borne pathogens (BBPs) is a risk for health care workers (HCWs). AIM: To study the pattern of occupational exposure to blood and body fluids (BBFs) at a tertiary care hospital. METHODS: This study reports a 17-year experience (1985-2001) of ongoing surveillance of HCW exposure to BBFs at a 420-bed academic tertiary care hospital. RESULTS: A total of 1,590 BBF exposure-related accidents were reported to the Infection Control Office. The trend showed a decrease in these exposures over the years with an average +/- standard error of 96 +/- 8.6 incidents per year. In the last 6 years, the average rate of BBF exposures was 0.57 per 100 admissions per year (average of needlestick injuries alone was 0.46 per 100 admissions). For 2001, the rates of exposure were found to be 13% for house officers, 9% for medical student, 8% for attending physicians, 5% for nurses, 4% for housekeeping, 4% for technicians and 2% for auxiliary services employees. The reason for the incident, when stated, was attributed to a procedural intervention (29%), improper disposal of sharps (18%), to recapping (11%) and to other causes (5%). CONCLUSIONS: The current study in Lebanon showed that exposure of HCWs to BBPs remains a problem. This can be projected to other hospitals in the country and raises the need to implement infection control standards more efficiently. Similar studies should be done prospectively on a yearly basis to study rates and identify high-risk groups.

Association between hepatitis A virus and Helicobacter pylori in a developing country: the saga continues.

BACKGROUND: The epidemiologic association between Helicobacter pylori and hepatitis A virus (HAV) has been evaluated by various different groups with conflicting conclusions. The aim of the present study was to determine the prevalence of HAV and H. pylori infection among adolescents attending high schools in Lebanon, and to identify the sociodemographic factors associated with their prevalence, individually and concurrently. METHODS: Nine hundred and two school students 14-18 years of age were selected randomly from 30 schools scattered all over Lebanon and tested for IgG antibodies against hepatitis A and H. pylori. Each student received a copy of a self-administered questionnaire to be completed by his/her parents inquiring about demographics, history of immunization, and prior viral hepatitis illness in the student. Bivariate analysis examined the association between different sociodemographic variables and prior HAV or H. pylori infection, and multivariate regression analysis was done to determine the factors independently associated with prior infection. RESULTS: Using ELISA the seroprevalence of antibodies against HAV was 71.3% as compared to 61.6% for anti-H. pylori. A total of 9.1% of those tested were negative for both agents. A multinomial regression analysis revealed that place of residence in relation to district or urban versus rural areas, in addition to mothers' education, were important determinants for the incidence of both agents. CONCLUSION: The low number of subjects negative for both H. pylori and HAV antibodies in Lebanon is indicative of their high prevalence in the country. It is possible that this high prevalence reflects an age-specific prevalence rather than a true association.