Association between dietary pattern and Helicobacter Pylori infection at Queen Elizabeth Hospital, Kota Kinabalu: A case-control study

BACKGROUND

Limited studies have reported the association between dietary patterns and Helicobacter pylori (H. pylori) infection in Sabah.

OBJECTIVE

The purpose of this study was to assess the association between dietary pattern and H. pylori infection among patients aged 18 years and above that went for first esophagogastroduodenoscopy (OGDS) in 2021 at Queen Elizabeth Hospital (QEH), Kota Kinabalu.

METHODS

Dietary intake of positive H. pylori was compared with healthy subjects by using questionnaire adapted from Malaysian Adult Nutrition Survey (MANS) 2014. Using logistic regression models, we evaluated the association between dietary pattern and H. pylori infection risk.

FINDINGS

Our finding identified four dietary patterns, namely "high carbohydrate pattern", "high fiber pattern", "high fat/cholesterol pattern" and "high salt pattern". After adjustment for potential confounders, the highest quartile of "high salt pattern" showed greater odds of H. pylori infection (OR = 1.26; 95% Cl: 1.032-1.459; P = 0.045) than lowest quartile, while highest quartile of "high fiber pattern" demonstrated lower odd of the infection (OR = 0.69; 95% Cl: 0.537-0.829; P = 0.008) than those in lowest quartile. If compared with Recommended Nutrient Intake (RNI) 2017, positive H. pylori consumed high carbohydrates and sodium with insufficient fiber intake.

CONCLUSION

To conclude, "high fiber pattern" lowers the risk of H. pylori infection while "high salt pattern" increases the infection risk. Our study also highlighted the importance of nutrient intake within daily allowances.

The effect of work setting and demographic factors on caring behaviour among nurses in the public hospitals and public health services, Sabah, Malaysia

BACKGROUND

The nursing profession's uniqueness contributes to the development of knowledge, experience, age, education, economy, and position, as well as a unique gender role. Thus, the development and advancement of demographic characteristics of nurses while in this profession influences their caring behavior.

OBJECTIVE

The purpose of this study was to determine the effect of work setting and demographic factors on nurses' caring behaviour, as well as the differences in nurses' caring behaviour based on demographic factors between nurses in public hospitals and nurses in public health services in Sabah, Malaysia.

METHODS

This research is a cross-sectional study using the survey method. Data were collected from 3,532 nurses (88.3% response rate) in public hospitals and public health services within Sabah, Malaysia. Data were analysed using two-way ANOVA.

RESULTS

The two-way ANOVA test revealed no significant impact of the work setting on CB, nor was there a notable interaction between the work setting and demographic factors influencing nurses' CB. However, demographic factors such as gender, age, education, economic status, position, and experience had a significant effect on CB.

CONCLUSION

The present research has provided convergent evidence on the effect of demographic factors on nurses caring behavior and the differences in caring behavior based on demographic factors among nurses in public hospitals and public health services in Sabah, Malaysia.

Short term recurrence and survival rate of breast cancer patients post surgical treatment; north borneo experience

Introduction

Breast cancer is the most common cancer among women and one of the major causes of mortality and morbidity worldwide. The aim of this study is to determine two-year cumulative recurrence rates and survival rates and their influential factors among women with breast cancer after surgical treatment.

Methods

The breast cancer registry with focus on patient's outcome after treatment was retrospectively review for relevant data. The study was started on 2019. All breast cancer patients who underwent surgical procedure between 2016 and 2019 were identified and recruited in this study and was follow up for two year. We performed Kaplan Meier method to determine 2-year recurrence rates and survival rates and compared unadjusted survival statistics using Log-rank test between baseline variables and outcomes.

Result

From 2016 to 2019, a total of 482 breast cancer patients underwent surgical procedure. The overall observed 2-year recurrence rate among breast cancer patients after surgical treatment was 11.8% (95%CI:8.5,16.4) while for the survival rate was 94.8% (95% CI:91.8,96.7). Log rank test showed that lymph node involvement (p < 0.001) and high lymph node ratio (p < 0.001) were associated with higher cumulative recurrence rates. Meanwhile, stage 4 breast cancer (p = 0.001), higher grade tumour (p = 0.011), larger tumour size (>5 cm) (P = 0.005) and type of tumour (p = 0.018) were demonstrated to have lower survival rates.

Conclusion

Recurrence rate were significant predictor among patient with lymph node involvement and higher lymph node ratio, while stages of tumour, tumour grade, size of tumour and type of tumour were all highly significant predictor for survival rate. Therefore, the aim for early diagnosis and management of breast cancer is crucial in improving the treatment outcome.

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The aim of this study is to determine two years cumulative recurrence rates and survival rates and their influential factors among women with breast cancer after surgical treatment in our centre.

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This is a retrospective cohort study of patients underwent surgical procedure from January 2, 0016 to December 2019.

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A total of 482 breast cancer patients underwent surgical procedure. The overall observed 2 years recurrence rate among breast cancer patients after surgical treatment was 11.8% (95%CI:8.5,16.4) while for the survival rate was 94.8% (95% CI:91.8,96.7). It showed that lymph node involvement (p < 0.001) and high lymph node ratio (p < 0.001) were associated with higher cumulative recurrence rates.

A rare case of breast squamous cell carcinoma and literature review

Introduction

Presentation of case

Discussion

Conclusion

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Breast Squamous Cell Carcinoma (SCC) is quite a rare tumour that the features portray squamous cell differentiation.

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This case highlights the need of early detection along with the obstacles faced in reaching an early diagnosis.

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The prognosis usually depends on the tumour size and the advance age of the patient.

Breast horn; A rare case presentation

Introduction

Breast Cutaneous Horn is a rare case whereby they are basically just nodules composed of keratin projecting above the surface the skin.

Presentation of case

A 63-year-old lady, para 6 presented with a horn like growth for the past 2 years associated with itchiness. The horn increased in size to about a length of 5 cm associated with on and off itchiness over the horn. No signs and symptoms of malignancy. As comorbidities, patient has hypertension and dyslipidemia which is well controlled on medications. An ultrasound of the breast revealed cutaneous lesion at upper quadrant associated with adjacent skin thickening and no extension into breast parenchyma. A bedside excision was done and the specimen was sent for Histopathology. Histopathology of the lesion revealed Verruca Vulgaris.

Discussion

This case brings to our attention a rare presentation of cutaneous horn over the breast along with its histological findings helping us to distinguish it with other similar cases. Best management would be by excision and to making sure to get a good specimen of the base for dermatopathological evaluation purpose.

Conclusion

Cutaneous horns are usually benign lesions. However, there are chances of it being malignant. Therefore, it is best for early intervention such as excision followed by histopathological review for further thorough management.

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It highlight a rare presentation of breast cutaneous horn in 63 year old lady.

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It is a challenging diagnostic dilemma in this kind of rare presentation especially in primary care level.

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It highlight the role of early intervention such as excision and then for histopathological review of the base for further thorough management.

The role of debridement in wound bed preparation in chronic wound: A narrative review

Objective

To provide an overview of the types of wound debridement and update the available scientific consensus on the effect of wound debridement.

Methods

The articles were searched through CINAHL, PubMed, Cochrane Library, and Medline database for relevant articles on all types of wound debridement. Articles included were all systematic review on the effectiveness of wound debridement-related outcome, published within the year 2017 until Aug 2021, in English.

Results

A total of seven scientific articles had been selected for review out of 318 screened. The authors reviewed a total of 318 titles and abstracts related to wound debridement effectiveness. Seven articles that were selected were narratively reviewed by two authors. The findings of the review were organized into autolytic, enzymatic, sharp, surgical, biological, and mechanical debridement methods and includes the advantages and disadvantages of each. The author further explored on the role of wound debridement according to wound bed preparation model. Articles were synthesized and organized based on the authors, year, total studies included in the systematic review, study range of year, total sample, debridement method, wound types, and findings.

Conclusion

Maggot debridement therapy showed a consistent finding in terms of effectiveness in debriding chronic wounds. The newer debridement method includes hydro-surgery, low-frequency ultrasonic and enzymatic collagenase debridement were getting more attention due to faster wound bed preparation and less painful. However, these newer method of debridements showed inconclusive findings and the patient safety was not clearly defined. A higher level of review is warranted in the future study.

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Maggot debridement therapy (MDT) showed a consistent positive effect in treating chronic wounds.

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New debridement methods that gaining more attention includes hydro-surgery, low-frequency ultrasonic and enzymatic collagenase debridement.

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Newer debridement method reported faster wound bed preparation and deemed to be less pain.

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Patient safety was not clearly defined in these newer debridement methods.

A challenge in soft tissue reconstruction: The use of pedicled anterolateral thigh fasciocutaneous flap and gluteal fasciocutaneous rotational flap in reconstructing a huge full thickness lateral trunk defect

Introduction and importance

Lateral abdominal wall (LAW) defect presents as a rare and unique challenge to the reconstructive surgeons.

Case presentation

We report a huge recurrent right lateral abdominal DFSP with local invasion in a 35-year-old lady. After wide local excision, the reconstruction was done by using pedicled anterolateral thigh fasciocutaneous flap and gluteal fasciocutaneous rotational flap.

Clinical discussion

The goal of reconstruction of the lateral abdominal wall is similar to that of the anterior abdominal wall, namely to provide a static repair that will not attenuate and form a bulge or hernia over time. Anchoring a mesh to stable fixation points is expected to ensure structural integrity in the LAW defect. However, we selected fascial inset from our flaps which did not lead to hernia formation or a bulge following a 7-month postoperative review. In terms of soft tissue coverage, the pedicled anterolateral thigh fasciocutaneous flap and gluteal fasciocutaneous rotational flap were used. The standard free flap will require more complexity of works, especially if the recipient vessels for microsurgical reconstruction are remotely situated or sometimes not even available.

Conclusion

Huge full-thickness LAW defect following an oncological resection can be reconstructed with combination of simpler locoregional flaps which yield good functional and aesthetic outcome.

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The lateral abdominal wall reconstruction is rarely discussed compared to the anterior abdominal wall reconstruction.

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The goal of reconstruction is to provide a static repair that will not stretch or attenuate and form a bulge or hernia over time.

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The full-thickness lateral abdominal wall defect was successfully reconstructed with pedicled anterolateral thigh fasciocutaneous flap and gluteal fasciocutaneous rotational flap.

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Pedicled anterolateral thigh fasciocutaneous flap has many advantages namely a long pedicle, a wide arc of rotation, a large potential skin paddle, and a low donor site morbidity.

Successful pregnancy in morbidly obese lady with polycystic ovary syndrome after bariatric surgery: A case report

INTRODUCTION

Obesity has been proven to have adverse effects on fertility and is one of the predisposing factors for delay in pregnancy even with the use of assisted reproductive technique. There are many pathways in which obesity can affect fertility such as anovulation, poor implantation and low-quality oocyte.

CASE PRESENTATION

We report a case of a 40-year-old lady with primary infertility for six years with underlying polycystic ovary syndrome (PCOS) and BMI 45.7 whom was successfully conceived twice following bariatric surgery procedure in which reduction of 70% of her BMI prior to bariatric surgery lead to her spontaneous conception without fertility intervention and successful live birth.

CLINICAL DISCUSSION

Obese PCOS needs multidisciplinary approaches which include weight loss program such as dietary advice, exercise intervention as part of preliminary treatment prior to ovulation induction and counselling.

CONCLUSION

Bariatric surgery has been a mainstay treatment in patients with morbid obesity and those with BMI more than 35 associated with obesity related problems such as joint pain, hypertension or diabetes mellitus. Bariatric surgery such as laparoscopic sleeve gastrectomy should be considered more often in contrast to lifestyle modification for morbidly obese lady with PCOS and infertility prior to the use of standard ovulation induction regime for treating infertility.

Challenges in electromyographic endotracheal tube (EMG ETT) placement via awake fibreoptic intubation during emergency thyroidectomy

Recurrent laryngeal nerve (RLN) injury is one of the main complications of total thyroidectomy. If the injury is bilateral, total airway obstruction, aphonia and hoarseness of voice could be precipitated. Hence, it is wise for the operating surgeon to be guided by neural monitoring during thyroidectomy. We present a valuable experience handling a middle-aged man with a huge papillary thyroid carcinoma . He needed an urgent thyroidectomy due to obstructive symptoms. We highlight our intraoperative dexterity in handling his surgery in the context of continuous monitoring of RLN using electromyography.

A case of rectal cancers in teenager: A conundrum of genetics and clinical medicine

Introduction

Signet cell carcinoma (SRCC)of the rectum is a rare subtype of the rectum cancer which accounts for only 0.8% of colorectal cancer in adolescents and young adults (AYAs) which spread aggressively to other organs and peritoneum.

Case presentation

We present a case of 15-year-old boy from rural area, presented with chronic diarrhea and per rectal bleeding for 3 months. The diagnosis was determined by colonoscope which revealed a fungating mass identified at 10cm from anal verge. Histological examination confirmed diagnosis of signet ring cell adenocarcinoma. CT scan of the abdomen showed thickening involving the recto-sigmoid colon and rectal mass, without evidence of distant metastatic disease. The patient's carcinoembryonic antigen level was within the normal range. He underwent a colostomy and was subjected to neoadjuvant CCRT and surgery.

Discussion

This CASE highlights the importance and challenges in achieving early diagnosis and surgical intervention of signet-ring cell carcinoma in adolescents, as most cases are detected at an advanced stage coupled with the scarcity of information on these rarer subtypes which leads to a poor prognosis.

Conclusion

In managing Signet cell carcinoma of the colorectal, physician have to know that it has a poor prognosis in patients of any age. However, in young teenagers delayed diagnosis and treatment option are narrowed to palliative management. Genetic profiling of family members and similar environment population may be a key to early detection.

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We present a case of 15-year-old boy from rural area, presented with chronic diarrhea and per rectal bleeding for 3 months. Histological examination confirmed diagnosis of signet ring cell adenocarcinoma.

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This case highlights the importance and challenges in achieving early diagnosis and surgical intervention of signet-ring cell carcinoma in adolescents.

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Most cases are detected at an advanced stage due to rarity of this subtypes which leads to a poor prognosis.

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Young teenagers delayed diagnosis and treatment option are narrowed to palliative management. Genetic profiling of family members and similar environment population may be a key to early detection.

Aggressive scalp and sternal lesion: A presentation of rare case of metastatic eccrine carcinoma

Introduction

Ductal Eccrine carcinoma (DEC) is a rare primary cutaneous tumor that exhibits both squamous and adnexal ductal differentiation. Due to its rarity in clinical practice we present as case of DEC and a literature review on the latest management of this rare disease.

Case presentation

We report a case 41 years old female presented with lesion on the scalp and sternal mass, increasing in size with itchiness and erythematous for 6 months duration. Further CECT scan of brain and neck shows features of malignant left frontal scalp lesion with poor plane with overlying skin and underlying skull bone and CECT of thorax shows a large, irregular heterogeneously enhancing mass with necrotic center noted at right hilar within superior segment of right lower lobe, encasing right middle and lower lobe bronchi. Wedge biopsy of scalp lesion showed an intradermal lesion extensively infiltrating by malignant gland accompanied by desmoplasia and the tumor cells are seen extending into the surgical margins suggestive of ductal eccrine carcinoma.

Clinical Discussion:This case highlights the importance and challenges in achieving early diagnosis coupled with the scarcity of information on these leads to difficulty in managing this patient.

Conclusion

In managing Ductal Eccrine Carcinoma tumor, standard method of treatment for has not been established. However, wide surgical excision is the treatment of choice for localized lesions. Regarding prognosis, there is conflicting data published which we describe in this article.

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We report a case 41 years old female presented with aggressive lesion on the scalp and sternal mass which biopsy confirm Ductal Eccrine Carcinoma (DEC).

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This case highlights the importance and challenges in achieving early diagnosis and surgical intervention for DEC. Most cases are detected at an advanced stage which leads to a poor prognosis.

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In managing DEC, due to its rarity of this disease, it require multidisciplinary approach to get the best outcome for the patient.

A clinically silent tumour of adrenal myelolipoma: A case report

Introduction

Adrenal myelolipoma is a rare, non-functional, benign neoplasm which is constituted of mature haematopoietic elements and adipose tissues in various proportions. It is diagnosed accidentally and frequently with the widespread use of imaging modalities.

Presentation of case

We report a 63-year-old lady with incidental findings of adrenal tumour on computed tomography (CT) scan during a routine medical check-up. She underwent tumour resection in view of a large tumour of 7 cm in size.

Discussion

CT scan is sensitive to diagnose adrenal myelolipoma in view of its fat-laden property and useful to monitor the tumour progress. Even previously she opted for conservative management; the decision for surgery was made in view of enlarging tumour and risk of surrounding tissue compression.

Conclusion

With increased awareness, the detection rate of this tumour is improving, hence able to prevent the complications of a large tumour such as compression, bleeding and tumour necrosis.