A prospective double-blinded randomized controlled trial of the efficacy of haruan (channa striatus) spray on clean wounds

Background Channa striatus (Haruan), a fresh water fish indigenous to many tropical countries have long been regarded as valuable food fish in the Far East. Several studies showed, the Haruan did contain all the essential amino acids and fatty acids uniquely capable of accelerating the wound healing and it has anti-nociceptive effect. However so far no human study been done to assess the effectiveness of Channa striatus in wound healing. A prospective randomize controlled trial has been conducted on the effect of Channa striatus Spray versus placebo on clean wound to assess its pain control effect and cosmetic outcome. Methodology Hundred and two patients (102) underwent clean elective surgery; post-operatively they are randomized into two group. One group received Channa striatus Extract spray (n=51) another group receive placebo (n=51) on daily basis for 2 week. Then they were follow up on 2nd, 4th and 6th week to assess the pain control effect based on Visual Analog Pain Score (VAPS) and cosmetic outcome based on Visual Analogue Cosmetic Scale (VACS), Wound Evaluation Scale(WES) and Vancouver Scar Scale (VSS). Result The patient treated with Channa striatus spray displayed a better outcome in term of pain control compared to placebo. During analysis using repeated measure ANOVA, there was significant difference of patient’s pain score based on VAPS between Channa striatus spray and placebo (F-stat(df) = 4.80 (2), p-value = 0.010). In term of cosmetic outcome it showed a consistent significant better result in haruan spray group for all the 3 scoring system which is VACS, (F-stat(df) = 2.68 (2) , p-value <0.001), WES (F-stat(df) = 3.09 (2), p-value = 0.048). and VSS , F-stat(df) = 1.72 (2) , p-value = 0.011). Conclusion Our study suggest that application of Haruan Extract spray on clean wound has shown a significant better pain score result and cosmetic outcome on week 2, week 4 and week 6 comparatively with placeb

Extracolonic manifestation of familial adenomatous polyposis in an asymptomatic patient; Literature review on current recommendation

Extracolonic manifestations of Familial Adenomatous Polyposis often associated with Gardner syndrome. We report a case of patient post panproctocolectomy with gastric and duodenal polyp found during upper GI scope. A rare condition which cause management dilemma as the patient asymptomatic. We review few literature regarding the latest recommendation on the management of extracolonic manifestation of FAP particularly gastric and duodenal polyposis in patient with FAP. Most expert agreed that duodenal polyposis should be manage based on Spigelman staging. For Stage 1 and Stage 2, recommended for surveillance. For Stage 3, require medical or endoscopic treatment while Stage 4, surgical option should be considered in patient age more than 35 years old

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

Reply on comments on ‘a lesson to learn in an Iatrogenic Perforation of Sigmoid Volvulus after Endoscopic Derotation’

Acute sigmoid volvulus is a surgical emergency, in which the initial treatment is endoscopic derotation in uncomplicated cases. Flatus tube dislodge is one of the common condition after endoscopic intervention. By performing a technique against the term of reference, management of a patient can skew towards a guarded outcome. I reply to comments on a paper concerning on iatrogenic bowel perforation after a successful endoscopic derotation of acute sigmoid volvulus

Synchronous Gastrointestinal Stromal Tumor (GIST) with pancreatic adenocarcinoma: A case report

Introduction: Gastrointestinal Stromal Tumors (GIST) are rare mesenchymal neoplasm of gastrointestinal tract. Stomach is the most common site affected by GIST compared to other places in gastrointestinal track. The coexistence of GIST with another malignancy represents a rare phenomenon with few literature reported. Case presentation: We present here 65 years old patient with stomach GIST and synchronous pancreatic adenocarcionoma discovered during surgery for suspected pancreatic mucinious cystadenoma. Distal pancreaticosplenectomy with excision of GIST Tumor & wedge resection of stomach was done. Histopathological examination of resected specimens reported the margins are clear. Discussion: In this article we discuss on the option of systemic therapy versus upfront surgery and their outcome benefit based on literature review. Conclusion: The coexistence of GIST with pancreatic adenocarcinoma is a rare condition. High clinical analysis needed during laparotomy for GIST to detect a synchronous tumor. In a case of GIST the surgeon should recognize the possibility of another tumor with different histological origin. Surgical excision is the mainstay of therapy and it has proven to be curative for our patient. . Due to its rare occurrence and limited literature further studies has to be done on GIST with other synchronous tumor to help the surgeon to manage the patient optimally

A clinically silent tumour of adrenal myelolipoma: A case report

ABSTRACT 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 necrosi

A rare case of breast squamous cell carcinoma and literature review

Introduction: Breast Squamous Cell Carcinoma (SCC) is quite a rare tumor that the features portray squamous cell differentiation. Presentation of case: We report a case of a 56-year-old female presented left breast lump that had been increasing in size for a 7 months duration associated with nipple retraction for one week. Ultrasound breast was done and revealed a large mixed echo density mass lesion in the left breast at 12 o’clock, 2cm from the nipple and measuring 4.2 × 3.4cm along with an enlarged node in the left axilla with thickened cortex and as for Mammogram revealed suspicious left breast lesion with enlarged axillary nodes, BIRADS 5. Histopathology from the left breast showed Invasive carcinoma with squamous differentiation, B5b, ER: negative, PR: Positive, Her2: Negative, CK5/6: Positive. Then a staging CECT Thorax, Abdomen and Pelvis was done which showed enhancing mass lesion seen at the left breast (4.1 × 4.3cm) with areas of necrosis within and multiple enlarged left axillary nodes seen with no local infiltration to the muscle or skin as well as no distant metastases. Patient underwent Neoadjuvant chemotherapy for 6 cycles and completed them. Discussion: This case highlights the crucial need of early detection along with the obstacles faced in reaching an early diagnosis tagged with the lack of guideline to manage this patient. Conclusion: In the management of Breast Squamous Cell Carcinoma, the standard treatment would be to go for mastectomy with axillary clearance. However, the prognosis usually depends on the tumor size and the advance age of the patient as described in this article

Breast horn; A rare case presentation

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

Filosofia da moda e teoria da constituição: uma abordagem interdisciplinar entre a moda e o diálogo de Lassale-Hesse

The following article aims to discuss the linkage between fashion philosophy and the constitutional theory, making a base theory for the fashion law study in a jusphilosophical and constitutional bias. Therefore, it employs the inductive method and develops qualitative, exploratory and representative research, since it begins with a description of both fields to build a broad theory. It has the support of philosophy and law bibliographical references and also analyzes the Constitution. It comprehends the fashion philosophy is connected to the post-modern concept of identity, which represents the consumerism as a factor of differentiation and personalization. It understands the fashion changes and it’s receptions by the consumer follows a similar phenomenology as the one previewed for the Constitution by Lassale-Hesse. At last, it concludes the fashion philosophy and the constitutional law are related based on the pluralistic social values attributed to both areas field of study.O presente artigo tem como objetivo discutir o paralelo entre a filosofia da moda e a teoria da Constituição, firmando uma base teórica para o estudo do direito da moda em uma perspectiva jusfilosófica e constitucional. Para tanto, emprega o método indutivo e elabora uma pesquisa qualitativa, exploratória e representativa, uma vez que parte da descrição de ambas as áreas para construir uma teoria mais ampla. Tem suporte de referenciais bibliográficos da filosofia e do direito, além de empreender análise do texto constitucional. Compreende que a filosofia da moda está interligada ao conceito de identidade na pós-modernidade, o que é representa o consumismo enquanto fator de diferenciação e personalização. Entende que as mudanças da moda e sua aceitação pelo consumidor contemplam uma fenomenologia semelhante aquela da Constituição conforme a dialética de Lassale-Hesse. Ao final, conclui que a filosofia moda e o direito constitucional estão interligados pelos valores sociais e pluralistas que são atribuídos aos objetos de estudo de ambas as áreas.

Blue rubber bleb nevus syndrome in a Malay girl: A case report and literature review

INTRODUCTION: Blue Rubber Bleb Nevus Syndrome (BRBNS) also known as Bean’s Syndrome is an atypical type of vascular malformation. To date, around 200 cases have been reported world-wide. In view of its low incidence rate, clinicians might misdiagnose and under treat. The key features of this syndrome are characterized by multiple cutaneous, soft tissue and gastrointestinal tract venous malformations. PRESENTATION OF CASE: We report the first case of Blue Rubber Bleb Nevus Syndrome in Malaysia, a 23 years old Malay girl who suffers from multiple cutaneous venous malformation and gastrointestinal bleeding episodes. DISCUSSION: The typical morbidity for this syndrome is symptomatic anemia due to secondary iron deficiency due to the gastrointestinal venous malformation bleeding. In managing the gastrointestinal bleeding, it mainly depends on the severity of gastrointestinal bleeding, some may resolve spontaneously, while the others may be needing blood transfusion, and some may require GIT resections. As for cutaneous lesions, normally it is innocuous depending on the region and size. Large or problematic cutaneous venous malformation might benefit from sclerotherapy or excision. CONCLUSION: Multidisciplinary approach is crucial in managing BRBNS case due to its complexity and the spectrum of multiple organ involvement to ensure the best outcome to the patien