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Fulltext Double Whammy: Duodenal Stenosis and Gastrointestinal Malrotation

Mustaqim K, Mohd Shah MS, Muhammad Asri NA

Cureus, 2023 Mar;15(3):e36137.
PMID: 37065346 DOI: 10.7759/cureus.36137

One of the main causes of proximal bowel obstruction in neonates is congenital duodenal obstruction. It can be grouped by intrinsic and extrinsic factors and the presentation may differ depending on whether the obstruction is complete or partial. The intrinsic factors include duodenal atresia, duodenal stenosis, or duodenal web. The extrinsic factors include malrotation with Ladd's band, annular pancreas, anterior portal vein, and duodenal duplication. Malrotation may present with or without midgut volvulus. We are sharing a rare presentation of congenital duodenal obstruction with combined intrinsic and extrinsic causes, namely, duodenal stenosis with gastrointestinal malrotation in a neonate. The patient underwent successful exploratory laparotomy, corrective Kimura's procedure (duodenostomy), Ladd's procedure, and appendicectomy. Early recognition of signs and symptoms, prompt corrective surgery, and adequate optimization of metabolic components post-operatively are important to determine the decreased morbidity and mortality of neonates.
Amelioration of inflammation in young men with cardiovascular risks participating pedometer-based walking programme

Omar NO, Ahmad RA, Mohd Shah MS, Aminuddin AA, Chellappan KC

Med J Malaysia, 2021 05;76(3):375-381.
PMID: 34031337

INTRODUCTION: Inflammation plays a central role in the pathogenesis of cardiovascular events. The lack of exercise among Malaysians and the increasing cardiovascular diseases among young men are of concern. The aim of this study was to evaluate the reducing of inflammation by measuring C-Reactive protein (CRP), interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α).
MATERIALS AND METHODS: A total of 70 young men (20 - 40 years) who were sedentary, achieving less than 5,000 steps/day in casual walking with 2 or more cardiovascular risk factors were recruited in Institute of Vocational Skills for Youth (IKBN Hulu Langat). Subjects were randomly assigned to a control group (CG) (n=34; no change in walking) and pedometer group (PG) (n=36; minimum target: 8,000 steps/day). All parameter was measured at baseline, at 6 weeks and after 12 weeks.
RESULTS: At post intervention, the CG step counts were similar (4983 ± 366vs 5697 ± 407steps/day). The PG significant increased step count from 4996 ± 805 to 10,128 ±511 steps/day (p<0.001). The PG showed significant improvement in anthropometric variables and lipid (time and group effect p<0.001). After intervention, CRP, IL-6 and TNF- α were significantly reduced for time and group effect (p<0.001). However, no changes were seen in CG.
CONCLUSION: The pedometer-based walking programme improved health status in terms of improving inflammation and arterial stiffness.
Fulltext Nodular Lymphoid Hyperplasia in Children: Recurrent Hematemesis

Che Husin N, Mohd Shah MS, Hassan MR, Wan Mohamad Noor WMR, Md Nor MT

Cureus, 2023 Jan;15(1):e34363.
PMID: 36874652 DOI: 10.7759/cureus.34363

Nodular lymphoid hyperplasia (NLH) is a pathology of the gastrointestinal tract that is commonly found in children. Most of its etiology is benign and associated with some underlying causes such as food hypersensitivity, viral or bacterial infection, giardiasis, Helicobacter pylori (H. pylori) infection, immunodeficiency, celiac disease, and inflammatory bowel disease. It is characterized by the growth of submucosal lymphoid tissue and a mucosal response to different types of noxious stimuli. In this report, we present the case of a child with recurrent hematemesis.
Fulltext Type III congenital pulmonary airway malformation associated with oesophageal atresia and tracheoesophageal fistula. A case report and review of literature

Fijasri NH, Muhammad Asri NA, Mohd Shah MS, Abd Samad MR, Omar N

Afr J Paediatr Surg, 2023;20(3):245-248.
PMID: 37470566 DOI: 10.4103/ajps.AJPS_10_21

Congenital pulmonary airway malformation (CPAM) together with oesophageal atresia and tracheoesophageal fistula (TOF) is a very rare condition in neonates. We presented a case of an infant with Gross type C oesophageal atresia with TOF coexisting with Stocker Type III CPAM in our centre. It is interesting to know that TOF associated with type III CPAM has never been reported in the literature. The child was delivered through caesarean section, and because of respiratory distress post-delivery, endotracheal intubation was carried out immediately. CPAM was diagnosed by a suspicious finding from the initial chest X-ray and the diagnosis was confirmed through computed tomography scan of the chest. The patient was initially stabilised in a neonatal intensive care unit (NICU), and after the successful ligation of fistula and surgical repair of TOF, lung recruitment was started by high flow oscillatory ventilation. The patient recovered well without complications and able to maintain good saturation without oxygen support through the stay in the neonatal unit. Early recognition of this rare association is essential for immediate transfer to NICU, the intervention of any early life-threatening complications, and for vigilant monitoring in the postoperative period.
Fulltext Comparing Low Volume Versus Conventional Volume of Polyethylene Glycol for Bowel Preparation during Colonoscopy: A Randomised Controlled Trial

Othman MF, Zakaria AD, Yahya MM, Md Hashim MN, Wan Mokhter WM, Wan Zain WZ, et al.

Malays J Med Sci, 2023 Oct;30(5):106-115.
PMID: 37928791 DOI: 10.21315/mjms2023.30.5.9

BACKGROUND: Polyethylene glycol (PEG) solution is widely used as a colonoscopic bowel cleaning agent, although some patients are intolerant due to the need for ingesting large solution volumes and unpleasant taste. A low-volume solution may enhance patient tolerability and compliance in bowel preparation. Accordingly, this study compared the effectiveness of two difference PEG volumes for bowel preparation before colonoscopy in terms of bowel cleanliness, completeness of colonoscopy, patient tolerability and colonoscopy duration.
METHODS: Using a prospective randomised controlled single-blinded study design, 164 patients scheduled for colonoscopy were allocated to two groups (n = 82 patients in each) to receive either the conventional PEG volume (3 L, control group) or the low volume (2 L, intervention group). The Boston Bowel Preparation Scale (BBPS), a validated scale for assessing bowel cleanliness during colonoscopy, was used to score bowel cleanliness in three colon segments. Secondarily, colonoscopy completeness, tolerability to drinking PEG and the duration of colonoscopy were compared between the groups.
RESULTS: There were no statistically significant differences between the two intervention groups in terms of bowel cleanliness (P = 0.119), colonoscopy completion (P = 0.535), tolerability (P = 0.190) or the amount of sedation/analgesia required (midazolam, P = 0.162; pethidine, P = 0.708). Only the duration of colonoscopy differed between the two groups (longer duration in the control group, P = 0.039).
CONCLUSION: Low-volume (2 L) PEG is as effective as the standard 3 L solution in bowel cleaning before colonoscopy; however, the superiority of either solution could not be established.