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Addressing unmet needs for patients with previous upper gastrointestinal bleed requiring concomitant aspirin and non-steroidal anti-inflammatory drugs

Jayaraman T, Wong MS, Mustaffa N, Lee YY

J R Coll Physicians Edinb, 2017 12;47(4):356-358.
PMID: 29537408 DOI: 10.4997/JRCPE.2017.411
Communication breakdown between physicians and IBS sufferers: what is the conundrum and how to overcome it?

Jayaraman T, Wong RK, Drossman DA, Lee YY

J R Coll Physicians Edinb, 2017 Jun;47(2):138-141.
PMID: 28675183 DOI: 10.4997/JRCPE.2017.206

Irritable bowel syndrome is a disorder of gut-brain interaction that leads to a significant healthcare burden worldwide. A good physician-patient relationship is fundamental in managing patients who suffer from this poorly understood chronic disease. We highlight possible reasons for breakdown in communication between physicians and irritable bowel syndrome sufferers and suggest possible ways to overcome such pitfalls.
Fulltext Epidemiological differences of common liver conditions between Asia and the West

Jayaraman T, Lee YY, Chan WK, Mahadeva S

JGH Open, 2020 Jun;4(3):332-339.
PMID: 32514433 DOI: 10.1002/jgh3.12275

Liver diseases form a heterogenous group of acute and chronic disorders of varying etiologies. Not only do they result in significant morbidity and mortality, but they also lead to a marked reduction in quality of life, together with a high socioeconomic burden globally. A better understanding of their global distribution is necessary to curb the massive health-care and socioeconomic burden that they entail. Notable differences and similarities have been described between common liver disease conditions occurring in Asia and the West (Europe and North America), giving rise to the need for an updated collective appraisal of this subject. In this review, the epidemiological differences of common liver conditions, specifically acute liver failure, drug-induced liver injury, acute-on-chronic liver failure, hepatocellular carcinoma, and non-alcoholic fatty liver disease, between Asia and the West are discussed.
Fulltext Hydroxyurea associated ileocecal valve ulcer: evidence for causality

Jayaraman T, Rajaram RB, Gan GG, Hilmi I

Intest Res, 2021 Oct;19(4):468-471.
PMID: 33249801 DOI: 10.5217/ir.2020.00099

Hydroxyurea is an antimetabolite drug that is commonly used in many hematological disorders. Ulcer formation in the gastrointestinal tract is a rare phenomenon associated with this drug. We report a case of a 73-year-old woman who was found to have an isolated ileocecal valve ulcer while on hydroxyurea 1 g daily for essential thrombocythemia. A comprehensive evaluation ruled out all other causes. The cytoreductive therapy was switched to anagrelide and the endoscopic evaluation 6 months later showed complete healing of the ulcer. However, the hydroxyurea was resumed due to increasing platelet counts and intolerance to dose increments of the anagrelide. Subsequently, the patient was found to have a recurrence of the ulcer. Apart from oral ulcers, there have also been reports of ulcers involving the small bowel and the colon associated with the use of hydroxyurea. The pathophysiology of the non-oral gastrointestinal ulceration in relation to this drug is unclear. Withdrawal of the drug typically leads to complete resolution. Increasing awareness of the rare association between the use of hydroxyurea and nonoral gastrointestinal ulcers is essential for early detection to prevent related complications.
Fulltext Clinical challenges in the management of hepatic sarcoidosis

Sinnanaidu RP, Jayaraman T, Rajaram RB, Wong Z, Mahadeva S

Singapore Med J, 2024 Apr 01.
PMID: 38567794 DOI: 10.4103/singaporemedj.SMJ-2022-067
Fulltext Development of bullous lung disease with pneumothorax following SARS-CoV-2 infection

Abdullah H, Wong YS, Ibrahim MA, Natasya Musa A, Jayaraman T, Mohd Zim MA

Respirol Case Rep, 2022 Sep;10(9):e01013.
PMID: 35928243 DOI: 10.1002/rcr2.1013

Cystic lung formation secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was described during coronavirus disease pandemic, but with relatively low prevalence. A rare yet under-recognized complication is that these cystic areas may progress to bullae, cavities and pneumothorax. We reported two cases of ruptured bullae with pneumothorax following SARS-CoV-2 infection. Two patients were discharged following SARS-CoV-2 pneumonia, which did not require invasive mechanical ventilation (IMV). However, both patients presented again a month later with shortness of breath. Repeated computed tomography (CT) thorax showed development of bullous lung disease and pneumothorax. The first patient underwent surgical intervention whilst the second patient was treated conservatively. Development of bullous lung disease following SARS-CoV-2 infection is rare but may be associated with serious morbidity. Patients whose general condition permits should be offered surgical intervention whilst conservative management is reserved for non-surgical candidates.
Fulltext Relationship between self-efficacy, self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus in the Malaysian primary care setting

Tharek Z, Ramli AS, Whitford DL, Ismail Z, Mohd Zulkifli M, Ahmad Sharoni SK, et al.

BMC Fam Pract, 2018 Mar 09;19(1):39.
PMID: 29523075 DOI: 10.1186/s12875-018-0725-6

BACKGROUND: Self-efficacy has been shown to be positively correlated with self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus. However, such evidence is lacking in the Malaysian primary care setting. The objectives of this study were to i) determine the levels of self-efficacy, self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus in the Malaysian primary care setting ii) determine the relationship between self-efficacy, self-care behaviour and glycaemic control iii) determine the factors associated with glycaemic control.

METHODS: This was a cross-sectional study involving patients with type 2 diabetes mellitus from two public primary care clinics in Malaysia. Self-efficacy and self-care behaviour levels were measured using previously translated and validated DMSES and SDSCA questionnaires in Malay versions, respectively. Glycaemic control was measured using HbA1c.

RESULTS: A total of 340 patients with type 2 diabetes mellitus were recruited. The total mean (±SD) of self-efficacy and self-care behaviour scores were 7.33 (±2.25) and 3.76 (±1.87), respectively. A positive relationship was found between self-efficacy and self-care behaviour (r 0.538, P
Fulltext Comparing Efficacy and Safety of Empirical vs. Guided Therapy for Non-cardiac Chest Pain: A Pragmatic Randomized Trial

Abdul Kadir NP, Ma ZF, Abdul Hafidz MI, Annamalai C, Jayaraman T, Hamid N, et al.

Front Med (Lausanne), 2021;8:605647.
PMID: 33659261 DOI: 10.3389/fmed.2021.605647

Background: Non-cardiac chest pain is common with two-thirds due to gastroesophageal reflux disease (GERD). Objective: To evaluate the effectiveness and safety of guided vs. empirical therapy in non-cardiac chest pain. Methods: Adults with normal angiogram or stress test were randomized into either a guided or empirical group. In the guided group, after the ambulatory pH-impedance test, if GERD then dexlansoprazole 30 mg/day for 8 weeks, but if functional or hypersensitive chest pain, then theophylline SR 250 mg/day for 4 weeks. In the empirical group, dexlansoprazole 60 mg/day was given for 2 weeks. The primary outcome was global chest pain visual analog score (VAS) and secondary outcomes were Quality of Life in Reflux and Dyspepsia (QOLRAD), GERD questionnaire (GERDQ), and pH parameters, all determined at baseline, 2nd and 8th weeks. Results: Of 200 screened patients, 132 were excluded, and of 68 randomized per-protocol, 33 were in the guided group and 35 in the empirical group. For between-group analysis, mean global pain scores were better with guided vs. empirical group at 8th week (P = 0.005) but not GERDQ or QOLRAD or any of pH measures (all P > 0.05). For within-group analysis, mean QOLRAD improved earliest at 8th week vs. baseline (P = 0.006) in the guided group and 2nd week vs. baseline (P = 0.011) in the empirical group but no differences were seen in other secondary outcomes (P > 0.05). No serious adverse events were reported. Conclusions: Guided approach may be preferred over short-term empirical therapy in symptom response, however QOLRAD, acid-related symptoms, or pH measures are not significantly different (trial registration ID no. NCT03319121).
Fulltext The potential of Olea europaea extracts to prevent TGFβ1-induced epithelial to mesenchymal transition in human nasal respiratory epithelial cells

Razali RA, Nik Ahmad Eid NAH, Jayaraman T, Amir Hassan MA, Azlan NQ, Ismail NF, et al.

BMC Complement Altern Med, 2018 Jun 26;18(1):197.
PMID: 29940929 DOI: 10.1186/s12906-018-2250-5

BACKGROUND: One of the molecular mechanisms involved in upper airway-related diseases is epithelial-to-mesenchymal transition (EMT). Olea europaea (OE) has anti-inflammatory properties and thus, great potential to prevent EMT. This study aimed to investigate the effect of OE on EMT in primary nasal human respiratory epithelial cells (RECs).
METHODS: Respiratory epithelial cells were isolated and divided into four groups: control (untreated), treated with 0.05% OE (OE group), EMT induced with 5 ng/ml of transforming growth factor beta-1 (TGFβ1 group) and treated with 5 ng/ml TGFβ1 + 0.05% OE (TGFβ1 + OE group). The effects of OE treatment on growth kinetics, morphology and protein expression in RECs were evaluated. Immunocytochemistry analysis was performed to quantitate the total percentage of E-cadherin and vimentin expression from day 1 to day 3.
RESULTS: There were no significant differences between untreated RECs and OE-treated RECs in terms of their morphology, growth kinetics and protein expression. Induction with TGFβ1 caused RECs to have an elongated spindle shape, a slower proliferation rate, a higher expression of vimentin and a lower expression of E-cadherin compared with the control. Cells in the TGFβ1 + OE group had similar epithelial shape to untreated group however it had no significant differences in their proliferation rate when compared to TGFβ1-induced RECs. Cells treated with TGFβ1 + OE showed significantly reduced expression of vimentin and increased expression of E-cadherin compared with the TGFβ1 group (P
Fulltext Non-alcoholic fatty liver disease and obesity among adult donors are major challenges to living-donor liver transplantation: A single-center experience

Rajaram RB, Jayaraman T, Yoong BK, Koh PS, Loh PS, Koong JK, et al.

Asian J Surg, 2022 Jan;45(1):441-447.
PMID: 34384674 DOI: 10.1016/j.asjsur.2021.07.046

OBJECTIVES: Obesity and non-alcoholic fatty liver disease (NAFLD) are rampant in South East Asia. There is paucity of data exploring its' impact on donor suitability for living donor liver transplantation (LDLT). We aimed to describe and examine the factors related to non-utilization of potential donors in our LDLT programme.
METHODS: This is an analysis of prospectively collected data on potential donors for an adult LDLT programme, between January 2017 and December 2019.
RESULTS: Fifty-five donors for 33 potential recipients were evaluated. The mean age was 31.6 ± 8.5 years, 52.7% were female and the ethnic divisions were: Chinese (50.9%), Indian (25.5%) and Malay (23.6%). The mean body mass index (BMI) among potential donors was 25.1 ± 4.0 kg/m2; 25.5% of donors had normal BMI, 23.6% were overweight and 50.9% were obese. Using the CAP modality of Fibroscan®, we identified the following grades of hepatic steatosis: 36.6% S0, 19.5% S1, 2.4% S2 and 41.5% S3. The non-utilization rate of our donors was 74.5% (41/55) and the main reasons were significant hepatic steatosis and/or obesity. Compared to suitable donors, unsuitable donors had significantly greater mean BMI, mean CAP scores, higher rates of dyslipidaemia and NAFLD.
CONCLUSION: NAFLD and obesity represent major challenges to an emerging LDLT programme in Malaysia.