exudates and Liver-Diseases

Leptospirosis is a serious bacterial disease that affects both humans and animals. A wide range of symptoms have been described in humans; the disease in dogs is commonly associated with kidney and/or liver disease. In Malaysia, information about the common serovars infecting dogs is limited. Therefore, we investigated the occurrences of leptospirosis in 124 pet dogs diagnosed with kidney and/or liver disease. Blood, urine, abdominal effusion, and/or kidney and liver were collected from the dogs. Based on microscopic agglutination testing, 53 of 124 (42.7%) dogs were seropositive for leptospiral exposure. Sera were frequently positive to serovars Bataviae (

Topics: Animals; Dog Diseases; Dogs; Kidney; Leptospira; Leptospirosis; Liver Diseases; Malaysia; RNA, Ribosomal, 16S

Current knowledge on the clinical features and natural history of childhood primary sclerosing cholangitis - inflammatory bowel disease in Asia is limited. We described the presenting features and natural history of primary sclerosing cholangitis-inflammatory bowel disease seen in a cohort of Southeast Asian children.. We conducted a retrospective review of childhood primary sclerosing cholangitis-inflammatory bowel disease from three tertiary centers in Singapore and Malaysia.. Of 24 patients (boys, 58%; median age at diagnosis: 6.3 years) with primary sclerosing cholangitis-inflammatory bowel disease (ulcerative colitis, n = 21; Crohn's disease, n = 1; undifferentiated, n = 2), 63% (n = 15) were diagnosed during follow-up for colitis, and 21% (n = 5) presented with acute or chronic hepatitis, 17% (n = 4) presented simultaneously. Disease phenotype of liver involvement showed 79% had sclerosing cholangitis-autoimmune hepatitis overlap, 54% large duct disease, and 46% small duct disease. All patients received immunosuppression therapy. At final review after a median [±S.D.] duration follow-up of 4.7 [±3.8] years, 12.5% patients had normal liver enzymes, 75% persistent disease, and 12.5% liver failure. The proportion of patients with liver cirrhosis increased from 13% at diagnosis to 29%; 21% had portal hypertension, and 17% had liver dysfunction. One patient required liver transplant. Transplant-free survival was 95%. For colitis, 95% had pancolitis, 27% rectal sparing, and 11% backwash ileitis at initial presentation. At final review, 67% patients had quiescent bowel disease with immunosuppression. One patient who had UC with pancolitis which was diagnosed at 3 years old developed colorectal cancer at 22 years of age. All patients survived.. Liver disease in primary sclerosing cholangitis-inflammatory bowel disease in Asian children has variable severity. With immunosuppression, two-thirds of patients have quiescent bowel disease but the majority have persistent cholangitis and progressive liver disease.

Topics: Adolescent; Asian People; Child; Child, Preschool; Cholagogues and Choleretics; Cholangitis, Sclerosing; Cohort Studies; Colitis, Ulcerative; Crohn Disease; Disease Progression; Female; Hepatitis, Autoimmune; Humans; Hypertension, Portal; Immunosuppressive Agents; Inflammatory Bowel Diseases; Liver Cirrhosis, Biliary; Liver Diseases; Liver Transplantation; Malaysia; Male; Retrospective Studies; Singapore; Young Adult

To determine vitamin D status in children with chronic liver disease (CLD) in a tropical country.. Cross-sectional study in Malaysian children with CLD. Factors affecting serum vitamin D level (definition: deficient < 30 nmol/L; insufficient 30-50 nmol/L; sufficient ≥ 50 nmol/L) was analyzed.. Of the 59 children studied (males 32, 54%; median age 6.8 ± 5.3 years), the three most common causes were biliary atresia (n = 25), autoimmune hepatitis (n = 16) and sclerosing cholangitis (n = 6). The overall mean daily vitamin D intake was 715 ± 562 units/day. Thirteen (22%) patients had at least one clinical signs of rickets. Seventeen (29%) had serum bilirubin level ≥ 34 μmol/L. Eight (14%) children were deficient in vitamin D, eight (14%) were vitamin D-insufficient and 43 (73%) were sufficient. As compared with children with serum bilirubin <34 μmol/L, those with serum bilirubin ≥34 μmol/L were more likely to have rickets (24% vs. 65%; P < 0.002) and a lower serum vitamin D level (86.0 ± 54.9 nmol/L vs. 65.4 ± 48.2 nmol/L; P = 0.05) despite being given a significantly higher vitamin D dose (608 ± 571 vs. 970 ± 543 units/day; P = 0.008). The proportion of children with either deficient or insufficient vitamin D status was significantly higher in children with bilirubin level ≥34 μmol/L than in children <34 μmol/L (47% vs. 19%; P = 0.028).. Vitamin D deficiency and insufficiency is common in children with CLD in a tropical country. Regular monitoring of vitamin D status and screening for metabolic bone disease in all children with CLD is recommended. Higher dose of oral supplement or parenteral route should be considered, especially in those with bilirubin ≥34 μmol/L.

Topics: Adolescent; Child; Child, Preschool; Chronic Disease; Cross-Sectional Studies; Diet; Female; Humans; Infant; Liver Diseases; Malaysia; Male; Nutritional Status; Prevalence; Vitamin D; Vitamin D Deficiency; Vitamins

We aimed to adapt, translate and validate the Chronic Liver Disease Questionnaire (CLDQ) in Malaysian patients with chronic liver diseases of various aetiologies.. Tertiary level teaching institution in Malaysia.. The validation process involved 211 adult patients (English language n=101, Malay language n=110) with chronic liver disease. Characteristics of the study subjects were as follows: mean (SD) age was 56 (12.8) years, 58.3% were male and 41.7% female. The inclusion criteria were patients 18 years or older with chronic hepatitis and/or liver cirrhosis of any aetiology. The exclusion criteria were as follows: presence of hepatic encephalopathy, ongoing treatment with interferon and presence of other chronic conditions that have an impact on health-related quality of life (HRQOL).. A cross-sectional study was conducted. Cultural adaptation of the English version of the CLDQ was performed, and a Malay version was developed following standard forward-backward translation by independent native speakers. Psychometric properties of both versions were determined by assessing their internal consistency, test-retest reliability and discriminant and convergent validity.. Cronbach's alpha for internal consistency across the various domains of the CLDQ was 0.95 for the English version and 0.92 for the Malay version. Test-retest analysis showed excellent reliability with an intraclass correlation coefficient of 0.89 for the English version and 0.93 for the Malay version. The average scores of both the English and Malay versions of the CLDQ demonstrated adequate discriminant validity by differentiating between non-cirrhosis (English 6.3, Malay 6.1), compensated cirrhosis (English 5.6, Malay 6.0) and decompensated cirrhosis (English 5.1, Malay 4.9) (p<0.001). Convergent validity showed that correlation was fair between the English (ρ=0.59) and Malay (p=0.47) CLDQ versions with the EQ-5D, a generic HRQOL instrument.. The English and Malay versions of the CLDQ are reliable and valid disease-specific instruments for assessing HRQOL in Malaysian patients with chronic liver disease.

Topics: Chronic Disease; Cross-Sectional Studies; Female; Humans; Liver Diseases; Malaysia; Male; Middle Aged; Multilingualism; Psychometrics; Quality of Life; Reproducibility of Results; Severity of Illness Index; Surveys and Questionnaires; Translations

This study aimed to quantify and investigate factors affecting the health-related quality of life (HRQoL) in children with biliary atresia (BA) living with their native livers.. A cross-sectional study on the HRQoL using the PedsQL4.0 generic core scales in children with BA aged between 2 to 18 years followed up at the University Malaya Medical Centre (UMMC) in Malaysia was conducted. Two groups, consisting of healthy children and children with chronic liver disease (CLD) caused by other aetiologies, were recruited as controls.. Children with BA living with their native livers (n = 36; median (range) age: 7.4 (2 to 18) years; overall HRQoL score: 85.6) have a comparable HRQoL score with healthy children (n = 81; median age: 7.0 years; overall HQRoL score: 87.4; P = 0.504) as well as children with CLD (n = 44; median age: 4.3 years; overall score: 87.1; P = 0.563). The HRQoL of children with BA was not adversely affected by having 1 or more hospitalisations in the preceding 12 months, the presence of portal hypertension, older age at corrective surgery (>60 days), a lower level of serum albumin (≤34 g/L) or a higher blood international normalised ratio (INR) (≥1.2). Children who had liver transplantation for BA did not have a significantly better HRQoL as compared to those who had survived with their native livers (85.4 vs 85.7, P = 0.960).. HRQoL in children with BA living with their native livers is comparable to healthy children.

Topics: Adolescent; Age Factors; Biliary Atresia; Case-Control Studies; Child; Child, Preschool; Chronic Disease; Cross-Sectional Studies; Female; Health Status; Humans; Hypertension, Portal; Liver Diseases; Liver Transplantation; Malaysia; Male; Quality of Life; Serum Albumin

The influence of ethnicity on pain complicating ultrasound-guided percutaneous liver biopsy (US-guided PLB) and its clinical impact has not been reported to date.. Consecutive adults from a multiethnic background, undergoing an US-guided PLB, were independently assessed for pain up to 6 h after the procedure. Clinical and demographic parameters were analysed to determine independent predictors of significant pain after PLB. Willingness to undergo a repeat procedure was assessed 1 week after PLB.. Data from 203 patients (median age 50 years; 43.9% female; ethnicity: Malay 41.5%, Chinese 40%, Indian 18%; median BMI 27.7 kg/m; median waist circumference 92.0 cm) were analysed. Pain after US-guided PLB was experienced in 133 (61.1%) patients, with severity grades as follows: none, n=81 (39.9%); mild, n=56 (27.6%); moderate, n=51 (25.1%); and severe, n=15 (7.4%). Analgesia requirements correlated well with severity of pain. Independent predictors of significant pain after PLB (moderate and severe categories) in patients included age less than 50 years [odds ratio (OR) 3.0], female sex (OR 3.7), Indian ethnicity (OR 2.9) and Malay ethnicity (OR 2.7), but not number of needle passes, BMI and educational levels. Patients who experienced moderate/severe pain were less willing to undergo a repeat PLB compared with those who experienced mild/no pain (60.9 vs. 82.8%, P=0.001).. Ethnicity has an important role in the development of pain after US-guided PLB. This has a significant impact on willingness to repeat the procedure.

Topics: Adult; Anthropometry; Asian People; Biopsy, Needle; Female; Humans; Liver; Liver Diseases; Malaysia; Male; Middle Aged; Pain; Pain Measurement; Ultrasonography, Interventional

Transforming growth factor beta-1 (TGF-beta-1) is a multifunctional cytokine involved in the regulation of growth and differentiation of both normal and transformed cells. The main aim of this study was to determine whether TGF-beta-1 or alpha fetoprotein (AFP) or the combination of the two is a better indicator for hepatocellularcarcinoma (HCC). Serum TGF-beta-1 and AFP were measured by ELISA in 40 healthy subjects, 23 patients with hepatocellular carcinoma (HCC), 70 patients with hepatitis B, 26 patients with hepatitis C and 16 patients with liver cirrhosis (LC). Patients with liver diseases showed significantly higher serum TGF-beta-1 values (> 3 fold) compared to control subjects. As for serum AFP, significant elevation was only observed for HCC cases. Serum TGF-beta-1 exhibited higher percent sensitivity compared to serum AFP in all liver diseases. Combination of serum TGF-beta-1 and AFP increased specificities in all cases studied. In conclusion, serum TGF-beta-1 is a more sensitive marker for HCC when compared to serum AFP and its specificity is increased when combined with serum AFP.

Topics: Adolescent; Adult; Aged; alpha-Fetoproteins; Biomarkers, Tumor; Carcinoma, Hepatocellular; Case-Control Studies; Chronic Disease; Enzyme-Linked Immunosorbent Assay; Humans; Liver Diseases; Liver Neoplasms; Malaysia; Middle Aged; Sensitivity and Specificity; Transforming Growth Factor beta1

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Databases as Topic; Female; Humans; Liver Diseases; Malaysia; Male; Middle Aged; Prospective Studies; Registries; Retrospective Studies; Risk Factors; Young Adult

We conducted a prospective study to determine the role of alpha1-antitrypsin (alpha1AT) deficiency in the pathogenesis of neonatal cholestasis and other childhood liver diseases in a multi-ethnic Southeast Asian population.. Prospective patients with neonatal cholestasis (group 1), other liver diseases (group 2) and children with other medical conditions (group 3) referred to the Paediatric Unit, University of Malaya Medical Centre, Malaysia, from May 2002 to June 2005, were screened for alpha1AT level and phenotype. alpha1AT level below 80 mg/dL was considered as low.. Of the 114 patients (group 1, n = 53; group 2, n = 42; group 3, n = 19) screened, seven patients (6% of total; group 1, n = 1; group 2, n = 4; group 3, n = 2) had a alpha1AT level below 80 mg/dL. All had marginally low level (range 57-79 mg/dL), but none had a clinical diagnosis of alpha1AT deficiency. One patient had PiZ- heterozygous phenotype (alpha1AT level 217 mg/dL) while another patient had PiMS heterozygous.. alpha1AT deficiency is not an important cause of neonatal cholestasis and childhood liver diseases in Malaysian children. In Malaysian children with neonatal cholestasis or other liver diseases, routine assay for alpha1AT phenotype is not recommended if there is no family history of neonatal cholestasis of uncertain aetiology, or if alpha1AT level is above 80 mg/dL.

Topics: alpha 1-Antitrypsin; alpha 1-Antitrypsin Deficiency; Child; Child, Preschool; Cholestasis; Female; Hospitals, University; Humans; Infant; Infant, Newborn; Liver Diseases; Malaysia; Male; Phenotype; Prospective Studies

Liver disease is an important and serious condition in pregnancy. The Confidential Enquiries Into Maternal Deaths in Malaysia showed that there were 23 maternal deaths attributed to liver disease between 1991-1994. Over the same period, there were 1066 reported maternal deaths with 929 of them being due to direct and indirect causes. Thus 2.15% of such deaths were due to liver disease in Malaysia. The three main causes of maternal deaths due to liver disease in pregnancy were hepatitis (6 cases), acute fatty liver in pregnancy (6 cases) and septicaemia (4 cases). Liver disease is common at a mean of thirty weeks of gestation with a preponderance to women of low parity. Only two patients in this series had no antenatal care. The majority of cases (45.8%) presented between 28-37 weeks of gestation. All cases delivered by spontaneous vaginal delivery. Remediable factors that were identified included failure to appreciate the severity of disease. Case summaries of all the cases of maternal deaths due to liver disease are discussed and a guideline to management of liver disease in pregnancy presented.

Topics: Adult; Cause of Death; Female; Humans; Liver Diseases; Malaysia; Maternal Mortality; Pregnancy; Young Adult

Congo red screening of routine biopsies at the University Hospital Kuala Lumpur revealed the following categories of amyloidosis: systemic AL (5.9%); systemic AA (3.2%); isolated atrial (14%); primary localized cutaneous (7.5%); other primary localized deposits (3.2%); localized intratumour (58%); and dystrophic (8.6%). Unlike in the West, AA amyloidosis in this population was usually secondary to leprosy or tuberculosis. Liver involvement in AL amyloidosis was shown to exhibit a sinusoidal pattern and differed from the vascular pattern of AA amyloidosis. Within the category of AA amyloidosis, there were two patterns of renal involvement--glomerular and vascular, with the glomerular pattern carrying a more ominous clinical picture. Notable among the localized amyloidoses were isolated atrial amyloidosis complicating chronic rheumatic heart disease, intratumour amyloidosis within nasopharyngeal carcinomas and dystrophic amyloidosis which occurred in fibrotic tissues.

Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Amyloid; Amyloidosis; Biopsy; Child; Humans; Kidney Diseases; Leprosy; Liver Diseases; Malaysia; Middle Aged; Prevalence; Tuberculosis

Fourteen cases of sarcoidosis consisting of 7 male and 7 female patients with a mean age of 42.4 years were seen at the University Hospital from 1972 to 1990. There were 10 Indians, 2 Malays, and 2 Chinese. Twelve patients had thoracic involvement. The other common disease manifestations included weight loss, arthralgia, hepatomegaly, erythema nodosum, peripheral lymphadenopathy, and hypercalcaemia. At initial presentation, the disease was in radiographic stage I, II, and III in 8, 3 and one patient respectively. The Kveim test was positive in 7 out of 9 patients. Eight patients required steroid therapy.

Topics: Adult; Age Factors; Aged; Arthritis; China; Female; Follow-Up Studies; Hospitals, University; Humans; Hypercalcemia; India; Liver Diseases; Lung Diseases; Malaysia; Male; Middle Aged; Prednisolone; Radiography; Sarcoidosis

This study was undertaken to analyse the clinical spectrum of chronic liver disease (cirrhosis, and others with portal hypertension) in Kuala Lumpur. Eighty patients were diagnosed over a 6-year period. Twenty-two had biopsy proven cirrhosis while 58 others had portal hypertension with clinical and biochemical evidence of chronic liver disease. The commonest aetiology was alcohol (36%), followed by the idiopathic variety and hepatitis B. The male to female ratio was 4.4:1. Indians had a high prevalence of alcohol-associated chronic liver disease. Overall, ascites was the commonest presentation. Eight patients presented with hepatocellular carcinoma. Spontaneous bacterial peritonitis was diagnosed in 13% of patients undergoing abdominal paracentesis. Gallstones were detected in 37% of patients who underwent ultrasonography. Diabetes mellitus and peptic ulcer disease were noted in 22% and 31% of patients respectively.

Topics: Adult; Aged; Chronic Disease; Female; Humans; Liver Cirrhosis; Liver Diseases; Malaysia; Male; Middle Aged; Retrospective Studies

A pilot epidemiologic study of all cases of Reye and Reye-like syndromes was undertaken at 8 representative major hospitals in Peninsular Malaya from January 1st to December 31st 1986. The cases were classified as definitive Reye's syndrome, clinical Reye's syndrome and encephalo-hepatopathies. Less than 50% of cases reviewed fulfilled the National Center for Disease Control criteria for clinical Reye's syndrome. Causes of Reye-like syndromes/encephalo-hepatopathies included fulminant hepatitis, Japanese B encephalitis, dengue, septicaemia, and complex febrile fits. It was not possible to differentiate clinical Reye's syndrome from the other encephalo-hepatopathies by either the clinical features (except for jaundice) or biochemical parameters. Liver biopsy is necessary for a definitive diagnosis of Reye's syndrome in Malaysia, because of the high prevalence of Reye-like diseases. The mortality rate in the 2 groups of patients is similar. Ingestion of salicylates was not found to be significantly associated with Reye and Reye-like syndromes in this study.

Topics: Diagnosis, Differential; Encephalitis; Female; Humans; Infant; Liver Diseases; Malaysia; Male; Pilot Projects; Prospective Studies; Reye Syndrome

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy, Needle; China; Diagnostic Errors; Female; Humans; India; Liver Diseases; Malaysia; Male; Middle Aged

Two hundred eight-eight hepatic resections performed over the past 15 years are discussed. The safety and success achieved are attributed to the original work in Malaysia on the anatomy of the liver and its anomalies, the use of surgical instruments specially designed for hepatic resection, various types of resections devised and studies on aids to liver regeneration after resection. The diversity of the principles and practice of surgery in the Western countries compared with those in Malaysia is illustrated.

Topics: Calculi; Carcinoma, Hepatocellular; Cysts; Humans; Liver; Liver Abscess; Liver Diseases; Liver Neoplasms; Liver Regeneration; Malaysia; Surgical Instruments

We present a study of 288 hepatic resections carried out in Malaysia for the past fifteen years. First, we describe our indications for hepatic resectins which are not limited to hepatic trauma and hepatomas, but also include hepatic abscesses, cysts, intrahepatic calculi and hemangiomas. Second, we give a simplified classification of hepatic resections using accurate terminology. Third, we describe the safety of hepatic resections in our hands which we believe is due to specially designed surgical instruments and the accurate decision making process at surgery. We have had minimum postoperative mortality and no intraoperative deaths so far. Finally, while analysing each indication we have drawn vignettes from our experience for the past fifteen years.

Topics: Calculi; Carcinoma, Hepatocellular; Cysts; Hemangioma; Hepatectomy; Humans; Liver; Liver Abscess; Liver Diseases; Liver Neoplasms; Malaysia

Capillaria hepatica infection in wild rodents collected from the States of Kelantan, Selangor and Johore in Peninsular Malaysia since 1973 is reported. A total of 1,258 rodents consisting of 20 species of house, field and forest rats, and 7 species of squirrels were examined for the parasite and 17 species consisting of 111 murids and 1 flying squirrel were found infected. The house rat, Rattus norvegicus had the highest prevalence rate, followed by 3 species of field rats, R. tiomanicus, R. argentiventer and Bandicota indica. The prevalence of infection was low among forest rats with the exception of Lenothrix canus. Only 1 flying squirrel, Hylopetes spadiceus was found with the parasite. The prevalence of infection in relation to the host behaviour and habitats was discussed. C. hepatica appears to be widespread throughout Malaysia with a wide range of hosts among rodent species. Some new host records are presented herein.

Topics: Animals; Capillaria; Liver Diseases; Malaysia; Nematode Infections; Rats; Rodent Diseases; Sciuridae

The level of serum alpha-fetoprotein (AFP) was estimated by radioimmunoassay in 153 normal healthy Malysians of different ethnic groups. The mean level was 7.5 In1/ml (SD 2.28InU/ml). Among 330 patients with malignant tumors, 11 had increased levels of AFP. The only patient who had hepatoma had a very high level of serum AFP. High levels were also found in three of four patients with dysgerminoma of the ovary, in the only two patients with carcinoma of the testis, and in one patient with secondary carcinoma of the humerus of unknown origin. Lower, but significantly increased levels were observed in one patient (of 48) with breast carcinoma, one patient (of 8) with basal cell carcinoma of the nose, one patient (0f 27) with carcinoma of the lung, and one patient (of 59) with nasopharynegeal carcinoma.

Topics: Adult; alpha-Fetoproteins; Breast Neoplasms; Carcinoma, Hepatocellular; Female; Fetal Proteins; Humans; Liver Diseases; Liver Neoplasms; Malaysia; Male; Neoplasms; Nose Neoplasms; Ovarian Neoplasms; Pregnancy; Racial Groups; Testicular Neoplasms

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Liver Diseases; Liver Neoplasms; Malaysia; Male; Middle Aged; Radionuclide Imaging