exudates and Gastrointestinal-Hemorrhage

Bleeding risk scores (BRSs) aid in the assessment of oral anticoagulant-related bleeding risk in patients with atrial fibrillation. Ideally, the applicability of a BRS needs to be assessed, prior to its routine use in a population other than the original derivation cohort. Therefore, we evaluated the performance of 6 established BRSs to predict major or clinically relevant bleeding (CRB) events associated with the use of oral anticoagulant (OAC) among Malaysian patients.. The pharmacy supply database and the medical records of patients with non-valvular atrial fibrillation (NVAF) receiving warfarin, dabigatran or rivaroxaban at two tertiary hospitals were reviewed. Patients who experienced an OAC-associated major or CRB event within 12 months of follow-up, or who have received OAC therapy for at least 1 year, were identified. The BRSs were fitted separately into patient data. The discrimination and the calibration of these BRSs as well as the factors associated with bleeding events were then assessed.. A total of 1017 patients with at least 1-year follow-up period, or those who developed a bleeding event within 1 year of OAC use, were recruited. Of which, 23 patients experienced a first major bleeding event, whereas 76 patients, a first CRB event. Multivariate logistic regression results show that age of 75 or older, prior bleeding and male gender are associated with major bleeding events. On the other hand, prior gastrointestinal bleeding, a haematocrit value of less than 30% and renal impairment are independent predictors of CRB events. All the BRSs show a satisfactory calibration for major and CRB events. Among these BRSs, only HEMORR. To the best of our knowledge, this is the first evaluation study of the predictive performance of these 6 BRSs on clinically relevant bleeding events applied to the same cohort consisting of mainly Asian novel oral anticoagulant users. These BRSs show poor to acceptable predictive performance on OAC-induced major or CRB events. An improvement in the existing BRSs for OAC users is warranted.

Topics: Administration, Oral; Aged; Anticoagulants; Atrial Fibrillation; Female; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Logistic Models; Malaysia; Male; Retrospective Studies; Risk Assessment; Risk Factors; Stroke

Approximately one-third of patients with esophageal varices will develop bleeding which is a major cause of morbidity and mortality in patients with liver cirrhosis. Currently, the two most widely used modalities to prevent variceal bleeding are pharmacologic and oendoscopic variceal band ligation (EVL). However, EVL has been associated with significant complications. Hence we aim to evaluate and to identify the epidemiology, demography, and complications of EVL at our local Malaysian tertiary hospital.. This is a retrospective study of all the patients that had undergone endoscopic variceal surveillance at the Gastroenterology endoscopy unit, Serdang Hospital from 1st January 2015 to 31st March 2017. Patients' demography, aetiologies of liver cirrhosis, platelet level and international normalised ratio (INR) prior banding procedure, and the post EVL complications were recorded and further analysed with SPSS version 16.. In this study, 105 patients were screened for varices. Fifty-five of them had undergone EVL, with a quarter of the patients requiring repeated ligation. There was a male preponderance with 76.4%. 56.4% of patients were in age from 40-59 years. The majority of our patients were of the Malay ethnicity. The major aetiology for liver cirrhosis in our patients was viral hepatitis with Hepatitis C (31.0%), and Hepatitis B (20.0%). Most of our patients had platelet count >50,000 and INR <1.5 prior to EVL. There was no major complication in all of our subjects.. EVL is relatively safe and feasible treatment for prevention of oesophageal variceal bleeds with a low complication rate.

Topics: Adult; Esophageal and Gastric Varices; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Humans; Ligation; Malaysia; Male; Middle Aged; Retrospective Studies; Tertiary Care Centers; Young Adult

To examine the medical status of children with biliary atresia (BA) surviving with native livers.. In this cross-sectional review, data collected included complications of chronic liver disease (CLD) (cholangitis in the preceding 12 mo, portal hypertension, variceal bleeding, fractures, hepatopulmonary syndrome, portopulmonary hypertension) and laboratory indices (white cell and platelet counts, total bilirubin, albumin, international normalized ratio, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transpeptidase). Ideal medical outcome was defined as absence of clinical evidence of CLD or abnormal laboratory indices.. Fifty-two children [females = 32, 62%; median age 7.4 years,. Clinical or laboratory evidence of CLD are present in 98% of children with BA living with native livers after hepatoportoenterostomy. Portal hypertension and variceal bleeding may be seen in children younger than 5 years of age, underscoring the importance of medical surveillance for complications of BA starting at a young age.

Topics: Adolescent; Biliary Atresia; Child; Child, Preschool; Cholangitis; Chronic Disease; Cross-Sectional Studies; Esophageal and Gastric Varices; Female; Follow-Up Studies; Fractures, Bone; Gastrointestinal Hemorrhage; Hepatopulmonary Syndrome; Humans; Hypertension, Portal; Liver; Liver Function Tests; Malaysia; Male; Portoenterostomy, Hepatic

the aim of this study was to determine the usefulness of Rockall score in predicting outcomes of 30 days rebleeding, mortality and need for surgical intervention of bleeding gastric and duodenal ulcers.. this is a retrospective cohort study of all the emergency endoscopies performed in Hospital sultan Ismail from January 2009 to October 2014 for indications of upper gastrointestinal bleeding (UGIb). Data was extracted from hospital's electronic database and only non-variceal bleeds were included. Rockall score was calculated and outcomes of 30 days rebleeding, mortality and need for surgery was recorded. For each outcome, calibration was done using the Goodness-of-fit tests and discriminative ability was reflected by area under the receiver operating characteristic curve (AUROc).. A total of 1323 patients were included with a male preponderance of 64%. the overall rates of rebleeding were 11.2%, mortality rate of 8.7% and need for surgery was 2%. Low AUROc values for rebleeding (0.63), mortality (0.58) and surgery (0.67) showed poor discriminative ability of Rockall score. the Goodness-of-fit test also revealed that the scoring system was poorly calibrated in outcomes of rebleeding (p <0.001), mortality (p = 0.001) and surgery (p = 0.038) with p-value <0.05. Patients with high risk (scores ≥8) displayed highest rebleeding and mortality rates of 20% respectively in comparison to the moderate (score 3-7) and low (score ≤2) risk groups.. Rockall score has a poor discriminative ability and is poorly calibrated for rebleeding, mortality and need for surgery in upper gastrointestinal bleeding. However, it is the best tool we have now to stratify patients into risk groups.

Topics: Area Under Curve; Gastrointestinal Hemorrhage; Humans; Malaysia; Male; Prognosis; Recurrence; Retrospective Studies; Risk Assessment; Severity of Illness Index

Infantile-onset inflammatory bowel disease (IO-IBD) with the onset of disease before 12 mo of age, is a different disease entity from childhood IBD. We aimed to describe the clinical features, outcome and role of mutation in interleukin-10 (IL-10) and interleukin-10 receptors (IL-10R) in Asian children with IO-IBD.. All cases of IO-IBD, defined as onset of disease before 12 mo of age, seen at University Malaya Medical Center, Malaysia were reviewed. We performed mutational analysis for. Six [13%; CD = 3, ulcerative colitis (UC) = 2, IBD-unclassified (IBD-U) = 1] of the 48 children (CD = 25; UC = 23) with IBD have IO-IBD. At final review [median (range) duration of follow-up: 6.5 (3.0-20) years], three patients were in remission without immunosuppression [one each for post-colostomy (IBD-U), after standard immunosuppression (CD), and after total colectomy (UC)]. Three patients were on immunosuppression: one (UC) was in remission while two (both CD) had persistent disease. As compared with later-onset disease, IO-IBD were more likely to present with bloody diarrhea (100%. The clinical features of IO-IBD in this Asian cohort of children who were negative for

Topics: Adolescent; Age of Onset; Asian People; Biological Products; Child; Child, Preschool; Colectomy; Colitis, Ulcerative; Crohn Disease; Diarrhea; DNA Mutational Analysis; Enteral Nutrition; Female; Gastrointestinal Hemorrhage; Hepatitis, Autoimmune; Humans; Immunosuppression Therapy; Infant; Infant, Newborn; Inflammatory Bowel Diseases; Interleukin-10; Malaysia; Male; Mutation; Receptors, Interleukin-10

The working party statements aim to provide evidence and guidelines to practising doctors on the use of antiplatelet therapy and proton pump inhibitors (PPIs) in patients with cardiovascular risk as well as those at risk of gastrointestinal (GI) bleeding. Balancing the GI and cardiovascular risk and benefits of antiplatelet therapy and PPIs may sometimes pose a significant challenge to doctors. Concomitant use of anti-secretory medications has been shown to reduce the risk of GI bleeding but concerns have been raised on the potential interaction of PPIs and clopidogrel. Many new data have emerged on this topic but some can be confusing and at times controversial. These statements examined the supporting evidence in four main areas: rationale for antiplatelet therapy, risk factors of GI bleeding, PPI-clopidogrel interactions and timing for recommencing antiplatelet therapy after GI bleeding, and made appropriate recommendations.

Topics: Aspirin; Cardiovascular Diseases; Clopidogrel; Drug Interactions; Gastrointestinal Hemorrhage; Humans; Malaysia; Platelet Aggregation Inhibitors; Proton Pump Inhibitors; Ticlopidine

Knowledge is believed to be a driving factor for patients' early presentation for healthcare. This study was conducted to assess knowledge of colorectal cancer among subjects presenting with rectal bleeding and to determine its association with late presentation.. A cross-sectional study of 80 patients with rectal bleeding, aged 40 and above, was conducted between December 2008 and June 2009 in the endoscopy unit, University Kebangsaan Malaysia Medical Centre. The research instruments used in this study was a self-administered questionnaire including data on duration of rectal bleeding, first medical consultation and knowledge of colorectal cancer.. Sixty percent of subjects with rectal bleeding delayed seeking medical advice. Subjects were more aware of symptoms of non-colorectal cancers compared to symptoms of colorectal cancer. The majority of subjects (63.8%) correctly identified rectal bleeding as a symptom but were not aware of the best screening method to detect colorectal cancer. Half of the subjects knew increasing age and genetic background to be risk factors for colorectal carcinoma. However, knowledge of colorectal cancer was not found to be significantly associated with delay in seeking help.. Findings indicate poor awareness of colorectal cancer among the subjects. Although public education of colorectal cancer is important for early presentation on rectal bleeding, further studies are advocated to evaluate other factors influencing patients' help seeking behavior other than knowledge.

Topics: Adult; Aged; Aged, 80 and over; Colorectal Neoplasms; Cross-Sectional Studies; Delayed Diagnosis; Delivery of Health Care; Female; Gastrointestinal Hemorrhage; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Patient Acceptance of Health Care; Rectum; Referral and Consultation; Risk Factors; Surveys and Questionnaires

Patients' delay in the presentation with rectal bleeding had been identified as a factor for late diagnosis of colorectal cancer. This study was conducted to determine the prevalence of delay in consulting a medical practitioner and identifying associated factors.. A cross-sectional study of 80 patients with rectal bleeding, aged 40 and above, was conducted between December 2008 and June 2009 in the endoscopy unit, University Kebangsaan Malaysia Medical Centre. The self-administered questionnaire included data on sociodemographic, concern of rectal bleeding, whether patients sought initial advice, any self treatment prior to medical consultation and patients' opinion on causes of their own rectal bleeding.. The prevalence of delay in the presentation of rectal bleeding was 60%. Patients who were less worried (OR 9.6; 95% CI 3.3-27.5), who did not seek anyoneandapos;s advice (OR 11.8; 95% CI 3.8-36.8) and took some treatment before seeking medical consultation (OR 5.0; 95% CI 1.0-24.1) were significantly more likely to delay. Multiple logistic regression revealed that less worry of rectal bleeding and not seeking anyoneandapos;s advice were important predictors (p<0.05). The majority of patients attributed their bleeding to benign causes.. A high proportion of patients with rectal bleeding in the high risk group delayed in seeking medical advice. Public education needs to focus on interventions to reduce the delay in presenting and diagnosis of colorectal carcinoma.

Topics: Academic Medical Centers; Adult; Aged; Aged, 80 and over; Colorectal Neoplasms; Cross-Sectional Studies; Delayed Diagnosis; Female; Gastrointestinal Hemorrhage; Humans; Malaysia; Male; Middle Aged; Patient Acceptance of Health Care; Surveys and Questionnaires

We retrospectively analyzed all patients presenting with upper gastrointestinal bleeding to Seremban Hospital over a one-year period. A quarter of the oesophagogastro-duodenoscopies (OGD) performed were performed as emergency for upper gastrointestinal tract bleeding. Gastric ulcers and duodenal ulcers were the two most common findings. Our results suggest that there is a male preponderance of 2:1, the Chinese were more likely to be affected and the elderly (> 60 years) were at highest risk.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Endoscopy, Gastrointestinal; Female; Gastrointestinal Hemorrhage; Humans; Malaysia; Male; Middle Aged; Retrospective Studies; Risk Factors; Sex Factors

Despite advancements in endoscopy and pharmacology in the treatment of peptic ulcer disease the overall mortality has remained constant at 10% for the past four decades. The aim of this study was to determine the age, gender, racial distribution, incidence and causes of endoscopically diagnosed cases of upper gastrointestinal (UGI) bleeding to summarise treatments undertaken and to report their outcome. A prospective study of UGI bleeding in 128 patients was performed in two surgical wards of Kuala Lumpur Hospital, involving both elective and emergency admissions. The study group comprised of 113 (88.2%) males and 15 (11.7%) females. The mean age was 51.9 years (range 14 to 85 years) and 37.5% (48 of 128 patients) were older than 60 years. The Indian race was over-represented in all disease categories. Smoking (50.1%), alcohol consumption (37.5%), non-steroidal anti-inflammatory drugs (NSAIDs) (17.2%), traditional remedies (5.5%), anti-coagulants (2.3%) and steroids (0.8%) were among the risk factors reported. Common presenting symptoms and signs included malaena (68.8%), haematemesis (59.4%) and fresh per rectal bleeding (33.6%). The commonest causes of UGI bleeding were duodenal ulcer (32%), gastric ulcer (29.7%), erosions (duodenal and gastric) (21.9%), oesophageal varices (10.9%) and malignancy (3.9%). UGI bleeding was treated non-surgically in 90.6% of cases. Blood transfusions were required in 62.6% (67/107) of peptic ulcer disease patients. Surgical intervention for bleeding peptic ulcer occurred in around 10% of cases and involved under-running of the bleeding vessel in most high risk duodenal and gastric ulcer patients. The overall mortality from bleeding peptic ulcer disease was 4.7%. Six patients died from torrential UGI haemorrhage soon after presentation, without the establishment of a cause. Active resuscitative protocols, early endoscopy, more aggressive interventional therapy, early surgery by more senior surgeons, increasing intensive care unit beds and more active participation of multidisciplinary teams in co-ordinating management are among remedial measures advocated. Broader educational preventive strategies should target the causes of UGI bleeding.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Gastrointestinal Hemorrhage; Hospitals; Humans; Incidence; Malaysia; Male; Middle Aged; Risk Factors

Stool specimens of 104 primary schoolchildren (mean+/-SD age = 8.2+/-0.3 years) were examined for helminth eggs and for occult blood to investigate the possibility that trichuriasis causes occult intestinal bleeding in the absence of the overt Trichuris dysentery syndrome. A commercially available guaiac test was used to detect fecal occult blood. Sixty-one children had Trichuris infection, 11 of whom had heavy infections (> 10,000 eggs per gram of feces [epg]), and 53 had Ascaris infections. No hookworm infection was detected. Baseline screening yielded only one weakly positive occult blood test result in a child with a light (800 epg) Trichuris infection. Serial stool occult blood testing on the 11 subjects with heavy trichuriasis and 8 uninfected controls yielded a single weakly positive result in the control group. The results provide no evidence that trichuriasis predisposes to significant occult gastrointestinal bleeding in children in the absence of the dysenteric syndrome.

Topics: Animals; Ascariasis; Ascaris lumbricoides; Child; Feces; Female; Gastrointestinal Hemorrhage; Humans; Malaysia; Male; Occult Blood; Parasite Egg Count; Prevalence; Trichuriasis; Trichuris

Topics: Aged; Animals; Enteritis; Female; Gastritis; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Malaysia; Strongyloides stercoralis; Strongyloidiasis

Bleeding gastroesophageal varices is associated with a high morbidity and mortality. Forty-four cases of bleeding gastroesophageal varices were treated at the Department of Surgery, Universiti Kebangsaan Malaysia, General Hospital, Kuala Lumpur over four and a half years. Thirty-two of them had liver cirrhosis. Hepatitis B infection was noted in 13 and alcoholic abuse was present in 14 patients. Five patients had associated hepatoma. Thirty-four percent had gastric fundal varices and a third of these bled from them. A total of 179 endoscopic injection sclerotherapy sessions were performed averaging 4 per person. Rebleeding rate was 4% and mortality was high (50%) in these cases. It was concluded that injection sclerotherapy is a safe and effective means of controlling bleeding oesophageal varices. Operative surgery was employed in those who rebled after injection and would be considered in those in Child's A.

Topics: Adolescent; Adult; Aged; Child; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Malaysia; Male; Middle Aged; Pregnancy; Recurrence; Retrospective Studies; Sclerotherapy

A review of the records at a teaching hospital in Kelantan revealed that 175 new cases of peptic ulcer disease were diagnosed endoscopically over a period of 5 years. The ratio of duodenal to gastric ulcers was 2:1. Male patients outnumbered females by 2.7:1. There was a disproportionately high number of Chinese patients. A striking observation was that an unusually large proportion (45%) of patients had presented with acute gastrointestinal bleeding. The implication is that peptic ulcer disease in this region may be underdetected; the diagnosis often coming to light only after a serious complication has supervened.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Gastrointestinal Hemorrhage; Humans; Malaysia; Male; Middle Aged; Peptic Ulcer

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Duodenal Ulcer; Endoscopy; Female; Gastrointestinal Hemorrhage; Humans; Malaysia; Male; Middle Aged; Peptic Ulcer Hemorrhage; Stomach Ulcer

In a review of 112 patients with SLE nephritis treated between 1976 and 1982, 31 were known to have died. Renal failure (32.2%) was the commonest cause of death. Gastrointestinal haemorrhage (16%), infections (12.8%) and central nervous system involvement (6.5%) were important causes of death. Thirteen out of 17 patients dying in the presence of renal failure had initially presented with renal impairment. Renal biopsies in 16 patients who have died showed diffuse proliferative glomerulonephritis in all except 1 patient, and uraemia was the commonest cause of death in these patients. Pregnancies terminating in abortions were followed by complications in 5 patients. Discontinuation of steroid therapy by patients was followed by complications, and ended in death in 6 patients.

Topics: Adult; Female; Gastrointestinal Hemorrhage; Humans; Lupus Nephritis; Malaysia; Male; Patient Compliance; Uremia

A consecutive series of 2,277 patients presenting for upper gastrointestinal endoscopy was analysed. The following groups of patients were studied with reference to sex, race and dialect groups: those presenting with dyspepsia but no haemorrhage, those presenting with upper gastrointestinal haemorrhage, those with non-ulcer dyspepsia, gastric ulcer and duodenal ulcer. Males out-numbered females in all diagnostic groups. Male and female Malays were under-represented in all diagnostic groups when compared to the Singapore population. Amongst female Chinese, there was an excess of Cantonese patients and an under-representation of Teochew patients in most diagnostic groups. These dialect differences were not remarkable amongst male Chinese. The possible reasons for these differences and their significance are discussed.

Topics: Adolescent; Adult; Aged; Asian People; Child; Child, Preschool; China; Dyspepsia; Female; Gastrointestinal Hemorrhage; Humans; Infant; Infant, Newborn; Malaysia; Male; Middle Aged; Peptic Ulcer; Sex Factors; Singapore; White People

A review of 352 patients with primary liver cell carcinoma treated by the author is presented. The poor rate of resectability (7 per cent) has necessitated various forms of treatment over the years. These are described in detail. Based on this experience, the current form of treatment for nonresectable carcinoma is summarized. Although it is too early to assess this form of treatment, initial results appear to be promising. A second report in the near future is planned.

Topics: Age Factors; Alcoholism; alpha-Fetoproteins; Blood Donors; Carcinoma, Hepatocellular; Developing Countries; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Hepatectomy; Hepatic Artery; Hepatitis B Antigens; Humans; Liver Cirrhosis; Liver Neoplasms; Malaysia; Male; Mycotoxins; Nutrition Disorders; Prognosis; Racial Groups

Topics: Aged; Angina Pectoris; Animals; Arteriosclerosis Obliterans; Cerebrovascular Disorders; Chronic Disease; Drug Evaluation; Enzyme Therapy; Enzymes; Female; Gastrointestinal Hemorrhage; Hemolysin Proteins; Humans; Injections, Intravenous; Injections, Subcutaneous; Malaysia; Pregnancy; Snakes; Species Specificity; Time Factors; Venoms

Topics: Adolescent; Adult; Aged; Esophageal and Gastric Varices; Esophageal Neoplasms; Esophageal Stenosis; Esophagoplasty; Female; Gastrointestinal Hemorrhage; Humans; Malaysia; Male; Middle Aged; Mouth Neoplasms; Pharyngeal Neoplasms; Surgical Procedures, Operative

Topics: Animals; Culicidae; Dengue; Gastrointestinal Hemorrhage; Humans; Malaysia; Zoonoses