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 1stAugust 2010 to 31stJuly 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

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

Colorectal cancer screening using immunochemical fecal occult blood test

Fecal occult blood test (FOBT) screening has been shown to decrease the incidence and mortality of colorectal cancer (CRC). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the immunochemical fecal occult blood test (i-FOBT) in diagnosing CRC were assessed among the patients in a tertiary referral hospital in Malaysia. A total sample of 814 patients aged 16 to 85 years old who performed i-FOBT and endoscopic screenings was obtained. The patients were recruited for a retrospective investigation. Sensitivity, specificity, PPV, and NPV were derived for the CRC screenees. Out of the 814 patients screened using i-FOBT, half of them were above 59 years old (49.6%), and 36% had positive i-FOBT. Gender distribution was almost equal, where 53.4% of the patients were female, and 46.6% were male. Majority of the patients were Malays (56.6%), followed by Chinese (24.0%), Indians (16.5%), and others (2.9%). Among the 71 patients referred for colonoscopy, 57.7% and 42.3% corresponded to positive and negative i-FOBT cases, respectively. Polyps were found to be most common among the patients (25.6%), 7.0% were found positive for invasive CRC, and 35.2% had normal colonoscopic findings. There was a significant association between colonoscopic finding and positive i-FOBT (p=0.001). The sensitivity, specificity, PPV, and NPV for CRC detection were 66.7%, 43.0%, 9.8%, and 93.3%, respectively. The results indicate that i-FOBT is a useful tool in the detection of abnormalities in the lower gastrointestinal tract and therefore serves as a cornerstone for potential large-scale screening programmes

Appropriateness of proton pump inhibitors prescription in patients admitted to a Malaysian tertiary hospital

Introduction: Proton pump inhibitors (PPIs) are one of the commonest drug prescribed, however it is not without risk of adverse effects especially if the usage is inappropriate. We aimed to evaluate the frequency, indications and appropriateness of PPIs prescription among the medical inpatients, Serdang Hospital, which is a tertiary hospital in Malaysia. Materials and Methods:: This is a retrospective cross sectional study consisting of 4953 patients admitted to medical ward from 1st July 2016 to 31st March 2017, and their database were further analysed by Statistical Package for the Social Sciences for Windows (IBM SPSS Statistics 17.0). Unpaired t-test was performed to analyze the data collected. P < 0.05 (two-tailed) is considered significant. Their indications were cross-referenced against the indications adapted from the United States Food and Drug Administration (FDA). Results: 23.9% (1184/4953) of inpatients were using PPIs, and 63% (746/1184) of them recently started on PPI in the ward, with mean age of 59.7 years. More male patients were commenced on PPIs during hospitalization (P value < 0.05). Based on the FDA guideline, only 21.8% patients were indicated, 32.2% were borderline indicated, and 46.0% patients were not indicated in prescribing PPIs. Stress ulcer prophylaxis was the commonest indication, while anaemia with no evidence of gastrointestinal bleed was the main non-indication in starting PPIs. Only 11% of patients had performed the oesophago-gastro-duodenoscopy (OGDS) during the hospital stay. Conclusion: A majority of inpatients were inappropriately prescribed PPIs according to FDA guideline. More efforts should be initiated to improve the current situation of PPIs overutilization in Malaysia

Appropriateness of Proton pump inhibitors prescription in patients admitted to a Malaysian tertiary hospital

Introduction Proton pump inhibitors (PPIs) are one of the commonest drug prescribed, however it is not without risk of adverse effects especially if the usage is inappropriate. We aimed to evaluate the frequency, indications and appropriateness of PPIs prescription among the medical inpatients, Serdang Hospital, which is a tertiary hospital in Malaysia. Methods This is a cross sectional study consisting of 1184 patients admitted to medical ward and received PPI from 1st July 2016 to 31st March 2017, and their database were further analysed by SPSS Statistics 17.0. Unpaired t-test was performed to analyze the data collected. P < 0.05 (two-tailed) is considered significant. Their indications were cross-referenced against the indications adapted from the United States Food and Drug Administration (FDA). Results About 23.9% (1184/4953) of inpatients were using PPIs, and 63.0% (746/1184) of them recently started on PPI in the ward, with mean age of 59.7 years. More male patients were commenced on PPIs during hospitalization (P value < 0.05). Based on the FDA guideline, only 21.8% patients were indicated, 32.2% were borderline indicated, and 46.0% patients were not indicated in prescribing PPIs. Stress ulcer prophylaxis was the commonest indication, while anaemia with no evidence of gastrointestinal bleed was the main non-indication in starting PPIs. Only 11% of patients had performed the oesophago-gastro-duodenoscopy (OGDS) during the hospital stay. Conclusions 46.0% of inpatients were inappropriately prescribed PPIs according to FDA guideline. More efforts should be initiated to improve the current situation of PPIs overutilization in Malaysia

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 most common gastrointestinal cancers in the world. In the Asia- Pacific region, it is the fastest emerging gastrointestinal cancer. Level of awareness on CRC warning signs and risk factors in the rural population of Malaysia is reported of very low. The aim of this study was to assess the level of knowledge of CRC among the public at medical outpatient clinics in Serdang Hospital. The association between sociodemographic factors with level of knowledge among the respondents was further studied. Study design: A study was conducted among the non-CRC patients' relatives accompanying their relatives to the medical outpatient clinics in Serdang Hospital from 1st April to 31st August 2016. The study was carried out with cluster sampling method. Methods: The respondents were assessed using validated and modified Cancer Awareness Measures (CAM) questionnaire consists of three parts which are knowledge on warning signs, knowledge on risk factors and sociodemographic factors. All data were analysed using IBM SPSS Statistics 21.0. Results: Altogether 308 subjects completed the questionnaires. It was shown high percentage of good knowledge for warning signs and risk factors of CRC among the respondents. A significant association between age groups and level of income with level of knowledge on warning signs was observed. Conclusions: The level of knowledge of CRC among the general public in Serdang Hospital was sufficient. The respondents with higher income or younger age had higher level of knowledge regarding CRC

In vitro study of modulatory effects of Strobilanthes crispus extracts on human cDNA-expressed cytochrome P450 2A6 (CYP2A6) and CYP3A4

Aim: Cytochrome P450 (CYP) 2A6 and CYP3A4 play important roles in biotransformation of endogenous substances as well as xenobiotics. Strobilanthes crispus (L.) Blume (S. crispus) has been found to have anti-cancer activities and this was suggested to be due to inhibition of enzymes involved in metabolic activation of procarcinogens. The purpose of this study was to look into the potential inhibitory effects of various extracts (aqueous, hexane, chloroform, ethyl acetate, and methanol) of S. crispus from leaf and stem on human cDNA-expressed CYP2A6 and CYP3A4 activities. Methods: The activity of CYP2A6 was examined via a fluorescence-based 7-hydroxylase coumarin assay. Meanwhile, high performance liquid chromatography (HPLC)-based testosterone 6β-hydroxylase assay was established to assess CYP3A4 activity. Results: It was shown that none of the extracts from both leaf and stem potently inhibited CYP2A6 and CYP3A4 activities with IC50values above 100μg/ml. Conclusion: The anticancer potency of S. crispus is unlikely due to the modulation of CYP2A6 and CYP3A4 activities, while other mechanisms might be involved and merits further investigation. On the other hand, potential drug-herb interactions occurring between CYP2A6 and CYP3A4 substrates and S. crispus preparations is relatively low, which requires further investigations via in vivo animal as well as clinical studies

Aetiologies of liver cirrhosis among adult patients attending a hepatology clinic at Selangor, Malaysia

Liver cirrhosis is an important cause of morbidity and mortality. Our study aimed to describe the aetiologies of liver cirrhosis and its associated risk factors among adult patients attending the Hepatology Clinic, Serdang Hospital, Malaysia from 1st January 2010 to 30th June 2017. Aetiology was determined by patients’ medical history as well as biochemical and/or histological findings. The severity of the liver cirrhosis, together with the presence of complications and incidence of hepatocellular carcinoma were documented. A total of 357 adult patients were diagnosed with liver 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 determined most likely causes of liver 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 predominant among Chinese whereas alcohol consumption was mainly found among Indians, and Hepatitis C-linked liver 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. Hepatitis B viral infection remains the most common cause of cirrhosis among patients attending Hepatology Clinic, Serdang Hospital

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised