Clinical Validity and Reliability of the Malay Language Translations of Gastroesophageal Reflux Disease Questionnaire and Quality of Life in Reflux and Dyspepsia Questionnaire in a Primary Care Setting.

BACKGROUND: Gastroesophageal Reflux Disease Questionnaire (GERDQ) and Quality of Life in Reflux and Dyspepsia Questionnaire (QOLRAD) are reliable tools for evaluation of GERD. AIM: We aimed to test validity and reliability of Malay language translations of GERDQ and QOLRAD in a primary care setting. METHODS: The questionnaires were first translated into the Malay language (GERDQ-M and QOLRAD-M). Patients from primary care clinics with suspected GERD were recruited to complete GERDQ-M, QOLRAD-M, and Malay-translated 36-item short-form health survey (SF-36 or SF-36-M), and underwent endoscopy and 24-h pH-impedance test. RESULTS: A total of 104 (mean age 47.1 years, women 51.9%) participants were enrolled. The sensitivity and specificity for GERDQ-M cut-off score ≥8 were 90.2 and 77.4%, respectively. Based on this cut-off score, 54.7% had a high probability of GERD diagnosis. GERD-M score ≥8 vs. < 8 was associated with erosive esophagitis (p < 0.001), hiatus hernia (p = 0.03), greater DeMeester score (p = 0.001), and Zerbib scores for acid refluxes (p < 0.001) but not non-acid refluxes (p = 0.1). Mean total scores of QOLRAD-M and SF-36-M were correlated (r = 0.74, p < 0.001). GERDQ-M ≥8, erosive esophagitis, and DeMeester ≥14.72 were associated with impaired QOLRAD-M in all domains (all p < 0.02) but this was not seen with SF-36. CONCLUSIONS: GERDQ-M and QOLRAD-M are valid and reliable tools applicable in a primary care setting.

Diagnostic accuracy of reused Pronto Drytest and CLOtest in the detection of Helicobacter pylori infection.

BACKGROUND: Unchanged substrate in a negative rapid urease test may be reused to detect Helicobacter pylori (H. pylori). This could potentially reduce costs and wastage in low prevalence and resource-poor settings. We thus aimed to investigate the diagnostic accuracy of reused Pronto Dry and CLOtest kits, comparing this to the use of new Pronto Dry test kits and histopathological evaluation of gastric mucosal biopsies. METHODS: Using a cross-sectional study design, subjects who presented for upper endoscopy due to various non-emergent causes had gastric biopsies obtained at three adjacent sites. Biopsy samples were tested for H. pylori using a reused Pronto Dry test, a reused CLOtest, a new Pronto Dry test and histopathological examination. Concordance rates, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were then determined. RESULTS: A total of 410 subjects were recruited. The sensitivity and diagnostic accuracy of reused Pronto Dry tests were 72.60 % (95% CI, 61.44 - 81.51) and 94.15% (95% CI, 91.44 - 96.04) respectively. For reused CLOtests, the sensitivity and diagnostic accuracy were 93.15% (95% CI 85.95 - 97.04) and 98.29% (95% CI 96.52 - 99.17) respectively. There were more true positives for new and reused Pronto Dry pallets as compared to new and reused CLOtests when comparing colour change within 30 min vs. 31-60 min (P < 0.001 and P = 0.7 respectively). CONCLUSION: Negative Pronto Dry and CLOtest kits may be reused in a low prevalence setting where cost issues remain paramount. Reused CLOtest kits have better accuracy than reused Pronto Dry tests. Reused Pronto Dry tests however have a more rapid colour change whilst maintaining diagnostic accuracy.

Role of postoperative vasopressor use in occurrence of atrial fibrillation after coronary artery bypass grafting.

Vasopressor use is common after coronary artery bypass grafting surgery. This study evaluated the role of postoperative vasopressor use as a predictor of occurrence of atrial fibrillation after coronary artery bypass grafting and demonstrates that vasopressor use is an independent predictor of such an occurrence.

Role of postoperative use of adrenergic drugs in occurrence of atrial fibrillation after cardiac surgery.

BACKGROUND: Use of adrenergic (inotropic and vasopressor) drugs is common after cardiac surgery. HYPOTHESIS: The study was undertaken to evaluate the role of postoperative adrenergic drug use as a predictor of postoperative atrial fibrillation (AF) after cardiac surgery. METHODS: The study population consisted of 199 patients post cardiac surgery. Postoperative adrenergic drug use and the baseline and clinical variables were analyzed as possible predictors of postoperative AF. RESULTS: Of 199 patients, postoperative AF occurred in 59 patients (incidence 30%). The adrenergic drugs were used in 127 (64%) patients. Postoperative AF occurred in 49 of the 127 patients (39%) with and in 10 of the 72 patients (14%) without adrenergic drug use (p < 0.01). By univariate analyses, postoperative adrenergic drug use, age, left ventricular hypertrophy, left atrial size, valve surgery, aortic valve replacement, cross clamp time, bypass time, postoperative ventricular pacing, and hours in intensive care unit were predictors of development of postoperative AF. Atrial pacing was a predictor of freedom from developing AF. By multivariate logistic regression analysis, adrenergic drug use was an independent predictor of postoperative AF (odds ratio [OR] 3.35, 95% confidence interval [CI] 1.38-8.12, p = 0.016). Two other independent predictors were valve surgery (OR 2.88, 95% CI 1.31-6.35, p = 0.002) and age (OR 10.73, 95% CI 10.37-11.10, p = 0.0001). Adrenergic drug use, valve surgery, ventricular pacing, and age were predictors of time duration from surgery to the occurrence of AF. Drugs with predominantly beta1-adrenergic receptor affinity were associated with a higher incidence of postoperative AF (dopamine 44%, dobutamine 41% vs. phenylepherine 20%, p = 0.001). CONCLUSION: Use of adrenergic drugs is an independent predictor of postoperative AF after cardiac surgery.

Isolated noncompaction cardiomyopathy presenting with paroxysmal supraventricular tachycardia--case report and literature review.

Isolated noncompaction cardiomyopathy is an exceedingly rare congenital cardiomyopathy. A case of isolated noncompaction cardiomyopathy is reported and the literature on the subject collected through a comprehensive literature search is reviewed. Fewer than 100 cases of this condition have been reported. Isolated noncompaction cardiomyopathy is caused by a defect in cardiac morphogenesis resulting in an arrest of compaction of loose interwoven meshwork of myocardial fibers during intrauterine life, which results in severe systolic dysfunction as well as undue hypertrophy of the involved walls of the ventricles. Although the most frequent sites involved are left ventricular apex and inferior wall, involvement of other left ventricular walls and right ventricle has also been reported. Etiology of the isolated noncompaction of myocardium is not clear. Familial cases have been reported and the mode of inheritance is heterogeneous. In X-linked form of the disease, a locus has been found on Xq28, and mutations have been reported in G4.5 gene. The age of onset of symptoms ranges from infancy to the geriatric age. Patients with isolated noncompaction cardiomyopathy have a high incidence of heart failure, arrhythmias, and thromboembolism. The most common presentation is congestive heart failure. Arrhythmias include atrial arrhythmias, ventricular tachycardia, and sudden cardiac death. The patient reported in this article presented with paroxysmal supraventricular tachycardia. Echocardiography is the procedure of choice to establish diagnosis. Due to the lack of associated cardiac anomalies, antenatal detection is difficult. The treatment is that for congestive heart failure, arrhythmias, and thromboembolism. The end-stage congestive heart failure is managed with heart transplantation and potential life-threatening ventricular tachyarrhythmias with an implantable cardioverter defibrillator. Prognosis is poor and the common causes of death are intractable heart failure and sudden cardiac death.

Colorectal cancers in Saudi Arabia.

OBJECTIVE: The aim of this retrospective study is to delineate the histopathological profile of colorectal cancers seen at King AbdulAziz University Hospital, Jeddah, Kingdom of Saudi Arabia and to compare our findings with 12 other studies published in the literature from other areas of the Kingdom of Saudi Arabia. METHODS: Our study group consisted of 39 colorectal cancer patients, who were examined in the department of Histopathology at King AbdulAziz University Hospital, Jeddah, Kingdom of Saudi Arabia, over a period of 4 years from January 1996 to December 2000. The data was retrieved and analyzed. The histopathological characteristics of the tumor such as tumor differentiation, tumor Duke's staging and grade of all the tumors were studied and compared with age of the patients. RESULTS: We received 2552 gastrointestinal endoscopic specimens during a 4 year period; out of these 276 were colorectal specimens. We found 39 cases (21 males and 17 females) of colorectal cancer during this period, which constituted 1.5% of total endoscopic biopsies and 13.8% of colorectal biopsies. Among these cases there were 31 cases (81%, mean age 56) of colorectal adenocarcinoma, 3 cases (7.6%, mean age 35) of signet cell carcinoma, 2 cases (5%, mean age 55.5) of mucinous adenocarcinoma, one case (2.5%, age 68) of metastatic papillary carcinoma, one case of mixed mucin secreting signet cell carcinoma (2.5%, age 64) and one case (2.5%, age 55) of poorly differentiated squamous cell carcinoma. In our study 21% of patients presented in their 3rd decade of life, 18.4% in the 4th decade, 15.8% in the 5th decade, 26.3% in the 6th decade, 10.5% in the 7th decade and 7.9% in the 8th decade. CONCLUSION: Colorectal carcinoma showed frequent presentation in our population. Some malignant lesions showed early presentation as compared to United States of America, with 6.9% cases presenting at a young age and 23.6% of cases presented at middle age. In order to achieve early diagnosis, a comprehensive cancer education program should be planned and executed, and proper screening programs should be launched.

Gastric precancerous lesions are associated with gene variants in Helicobacter pylori-susceptible ethnic Malays.

AIM: To identify genes associated with gastric precancerous lesions in Helicobacter pylori (H. pylori)-susceptible ethnic Malays. METHODS: Twenty-three Malay subjects with H. pylori infection and gastric precancerous lesions identified during endoscopy were included as "cases". Thirty-seven Malay subjects who were H. pylori negative and had no precancerous lesions were included as "controls". Venous blood was collected for genotyping with Affymetrix 50K Xba1 kit. Genotypes with call rates < 90% for autosomal single nucleotide polymorphisms (SNPs) were excluded. For each precancerous lesion, associated SNPs were identified from Manhattan plots, and only SNPs with a χ² P value < 0.05 and Hardy Weinberg Equilibrium P value > 0.5 was considered as significant markers. RESULTS: Of the 23 H. pylori-positive subjects recruited, one sample was excluded from further analysis due to a low genotyping call rate. Of the 22 H. pylori-positive samples, atrophic gastritis only was present in 50.0%, complete intestinal metaplasia was present in 18.25%, both incomplete intestinal metaplasia and dysplasia was present in 22.7%, and dysplasia only was present in 9.1%. SNPs rs9315542 (UFM1 gene), rs6878265 (THBS4 gene), rs1042194 (CYP2C19 gene) and rs10505799 (MGST1 gene) were significantly associated with atrophic gastritis, complete intestinal metaplasia, incomplete metaplasia with foci of dysplasia and dysplasia, respectively. Allele frequencies in "cases" vs "controls" for rs9315542, rs6878265, rs1042194 and rs10505799 were 0.4 vs 0.06, 0.6 vs 0.01, 0.6 vs 0.01 and 0.5 vs 0.02, respectively. CONCLUSION: Genetic variants possibly related to gastric precancerous lesions in ethnic Malays susceptible to H. pylori infection were identified for testing in subsequent trials.