Diamond Joy - Academia.edu (original) (raw)

Papers by Diamond Joy

Poster: "ECR 2006 / C-486 / Early ERCP complications: Prospective study from a radiologist l... more Poster: "ECR 2006 / C-486 / Early ERCP complications: Prospective study from a radiologist led single centre" by: "G. Puppala1, D. Joy2, S. Agarwal1, E. Hicks2; 1Cardiff/UK, 2Pontypridd/UK"

Open Journal of Gastroenterology and Hepatology, 2020

Background: Most studies describing clinical features and associations of celiac disease come fro... more Background: Most studies describing clinical features and associations of celiac disease come from the studies conducted in the western world. Our aim was to determine the clinical features and associations of Celiac disease from our centre serving a Middle East population in Saudi Arabia. Methods: This retrospective study was conducted in a health care provider serving the Eastern Province of Saudi Arabia. All patients with biopsy-confirmed celiac disease receiving health care at our centre between April 2002 and December 2018 were identified. Individual case records were reviewed. In addition, the Slicer Dicer function was also used from the Electronic medical health record [EPIC] for analysing the clinical features and associations. Results: We analyzed the clinical features of 149 patients with Celiac disease. 66% of these were females. There was progressively increased yield of confirmed Celiac disease over the study period. This was paralleled by an increase in TTG antibody tests performed year by year. 77 (51.6%) patients had gastrointestinal symptoms. 26% of patients had iron deficiency anemia. 24 patients (16%) had diabetes, of which 46% were type 2. 18 (12%) patients had osteoporosis or osteopenia, and 28 (19%) had various skin diseases. Conclusion: In Saudi Arabia, celiac disease is being increasingly recognized, largely because of increased awareness and increasing TTG antibody testing. Many patients present with non-gastrointestinal symptoms. Knowledge about the varied clinical features and the targeted use of celiac serology should lead to even earlier recognition of the disease.

The Journal of Infection in Developing Countries, 2017

Introduction: Various objective scoring systems were developed to standardize the approach to the... more Introduction: Various objective scoring systems were developed to standardize the approach to the designation of severity of community-acquired pneumonia (CAP). There is limited data on the use of CURB-65 among admitted CAP patients in Saudi Arabia. Methodology: The retrospective study included CAP patients, admitted to a general hospital in Eastern Saudi Arabia. The CURB-65 was extracted from the available medical records. Results: During the study period, from 2013 to 2016, a total of 1786 adults were admitted with a mean age of 63.9 ± 21.7 (range 14-108 years). The majority of the patients (51.7%) had CURB-65 score 0 or 1 followed by the score 2, 3 and 4/5 (29%, 15.2%, and 4.1%, respectively). The mean CURB-65 was 1.4 ± 1.12 for those who survived and 2.27 ± 1.03 for those who died (p < 0.001). The mean age was 63.01± 21.9 years for survived patients and 75.1 ± 15.58 years for fatal cases (p < 0.001). The overall 30-day crude mortality rate was 7.6%. The mortality rates f...

Gastroenterology & Hepatology: Open Access, 2017

With the pandemic of obesity, bariatric surgery in gaining popularity. Bariatric surgery increase... more With the pandemic of obesity, bariatric surgery in gaining popularity. Bariatric surgery increases the risk of gall stone disease. This is a case report of a young woman who presented with symptomatic choledocholithiasis and cholelithiasis. She has previous Roux-en-Y bariatric surgery for obesity 4 years ago which made standard Endoscopic Retrograde Cholangiography (ERC) not feasible. Therefore, ERC was attempted using a conventional colonoscope but was unsuccessful. She later underwent Laparoscopy and ERC via gastric stoma followed by subsequent cholecystectomy. There was close collaboration between the surgeon and the endoscopist to harmonize their timetable for the combined procedure. The aim of this paper is to report this case of laparoscopically assisted ERCP (LA-ERCP) combined with cholecystectomy, technical challenges and highlight the difficulties encountered when dealing with choledocholithiasis in such patients who have undergone previous bariatic surgery.

Journal of gastrointestinal and liver diseases : JGLD, 2016

Pancreatic exocrine insufficiency may be under recognised in gastroenterological practice. We aim... more Pancreatic exocrine insufficiency may be under recognised in gastroenterological practice. We aimed to identify the prevalence of pancreatic insufficiency in secondary care gastroenterology clinics and determine if co-morbidity or presenting symptoms could predict diagnosis. A secondary aim was to assess response to treatment. A dual centre retrospective analysis was conducted in secondary care gastroenterology clinics. Patients tested for pancreatic exocrine insufficiency with faecal elastase-1 (FEL-1) between 2009 and 2013 were identified in two centres. Demographics, indication and co-morbidities were recorded in addition to dose and response to pancreatic enzyme replacement therapy. Binary logistic regression was used to assess if symptoms or co-morbidities could predict pancreatic insufficiency. 1821 patients were tested, 13.1% had low FEL-1 (<200µg/g). This prevalence was sub-analysed with 5.4% having FEL-1 100-200µg/g (mild insufficiency) and 7.6% having faecal elastase re...

Gut, 2015

managing physicians. This could lead to a missed opportunity to reduce symptoms and improve quali... more managing physicians. This could lead to a missed opportunity to reduce symptoms and improve quality of life in patients with a simple intervention. A referral to the dietician was shown to benefit these patients.

Gastrointestinal Nursing, 2010

Pancreaticobiliary disorders are common in clinical practice and often require complex investigat... more Pancreaticobiliary disorders are common in clinical practice and often require complex investigations before a final diagnosis and management plan is formulated. Many patients will undergo an endoscopic investigation or therapy, both of which can be challenging. Endoscopic ultrasound is increasingly used as one of the modalities for investigating and treating such patients and the indications for interventional endoscopic ultrasound appear to be increasing. In this review article, the role of endoscopic ultrasound in the investigation pathway of patients with benign and malignant pancreaticobiliary diseases will be considered. The limitations of endoscopic ultrasound and some areas of future expansion will also be discussed.

Scandinavian Journal of Gastroenterology, 2011

The diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been... more The diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been suggested as a benchmark of quality performance in EUS. However, there is paucity of data on the training requirement for competency in EUS-FNA of the pancreas. KO commenced the service without prior formal training in EUS-FNA. A formally trained colleague (MN) who underwent a fellowship in the same unit was appointed to a substantive post in 2007. The aims of the study were to assess if a dedicated training program in pancreaticobiliary (PB) EUS-FNA of solid lesions: (1) produced better results at the outset of independent practice than produced at the initiation of service without formal training and (2) produced results comparable with those of an experienced endosonographer. This is a retrospective review comparing the first 80 consecutive cases at the onset of practice of operator KO1 (2003/2004) and MN (2007/2008) as well as consecutive cases of operator KO2 (2007/2008) in the same time frame as the initial cases of operator MN. There was a significant difference in EUS-FNA sensitivity for pancreatic malignancy between operator KO1 (56%) and operator MN (77%) p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05. There was no significant difference in test performance between operator KO2 (82%) and MN (77%) (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Our data show that formal training in PB EUS produces test performance at the outset of independent practice that is comparable with an experienced endosonographer, in line with the published standards for EUS-FNA of the pancreas and significantly better than that achieved without training.

Gut, 2003

I would like to thank Joy and Scott for their comments in their letter in response to my review (... more I would like to thank Joy and Scott for their comments in their letter in response to my review (Gut 2002;51:9-10). 1 I entirely agree with their view that ultrasound is highly specific and sensitive for the diagnosis of fatty liver. However, I do not feel that the presence or absence of fatty liver is the issue here. It is established that approximately 30% of patients with fatty liver who have significant fibrosis will go on to develop chronic liver disease and cirrhosis, with all its complications, including hepatoma. 2 The purpose of histological sampling is not to confirm the presence of fatty liver but to see whether fibrosis and other abnormalities are present, putting the patient at risk of developing chronic liver disease. This issue was addressed in a recent article by Saadeh and colleagues 3 who compared patients with non-alcoholic steatohepatitis (NASH) and those with steatosis (nonalcoholic fatty liver disease (NAFLD)) alone. The authors evaluated the role of various radiological modalities, including ultrasound, computed tomography, and magnetic resonance imaging, in the role of distinguishing between NASH and the less aggressive forms of NAFLD. Their conclusion was that none of the radiological modalities detected the presence of hepatocyte ballooning, Mallory's hyaline, or fibrosis, which are the important features in the diagnosis of NASH. The study showed that ultrasound had high sensitivity and specificity for the diagnosis of severe steatosis but it confirmed that ultrasound had no predictive value in the diagnosis of fibrosis or cirrhosis. On the basis of this article together with earlier studies, I can find no basis for the conclusion reached by Joy and Scott that ultrasound is a reasonable alternative to liver biopsy for patients who have abnormal liver function tests with no diagnostic serology.

Gastrointestinal Endoscopy, 2006

首页旧版入口知识脉络投稿专题相似性检测更多 ▼. 学术统计分析专利分析(试用) 跨库检索新方志电力行业版冶金行业版移动阅读; 查新咨询服务中心科技文献身份证核查编审平... more 首页旧版入口知识脉络投稿专题相似性检测更多 ▼. 学术统计分析专利分析(试用) 跨库检索新方志电力行业版冶金行业版移动阅读; 查新咨询服务中心科技文献身份证核查编审平台 DOI注册 OA论文托管期刊统计分析. 登录 | 注册 | 充值 | 帮助. ...

European Journal of Gastroenterology & Hepatology, 2003

Non-alcoholic fatty liver disease is increasingly being recognized as an important and common con... more Non-alcoholic fatty liver disease is increasingly being recognized as an important and common condition, affecting approximately 20% of the general population. Although liver biopsy is currently the gold standard for diagnosis, there is a need for less invasive methods. Imaging by ultrasound, computerized tomography and magnetic resonance are all able to demonstrate fat. In this paper, these three imaging techniques are critically assessed. Ultrasound, although probably not the most reliable imaging method, has many advantages and, when positive, gives a high degree of certainty of the diagnosis depending on the prevalence of fatty liver in the population being studied. Unlike liver biopsy, none of these techniques is able to differentiate simple steatosis from non-alcoholic steatohepatitis.

Climacteric, 2008

The health scares restricting the use of hormone replacement therapy have made women tend to opt ... more The health scares restricting the use of hormone replacement therapy have made women tend to opt for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;natural&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; remedies that are generally perceived as safe. Unfortunately, there is lack of definite opinion on the safety of herbal remedies. Black cohosh is commonly used for postmenopausal symptoms. We present two cases of liver toxicity related to this and recommend close monitoring of women on this herbal preparation.

Pancreas, 2015

Double-duct sign (combined dilatation of the common bile duct and pancreatic duct) is an infreque... more Double-duct sign (combined dilatation of the common bile duct and pancreatic duct) is an infrequently encountered finding in cross-sectional radiological imaging of the pancreatobiliary system. This sign is commonly deemed to signify on ominous pathology and suggests the presence of pancreatic or biliary malignancy. We aim to correlate double-duct sign discovered on magnetic resonance cholangiopancreatogram (MRCP) in the clinical context. We retrospectively analyzed MRCP database over a period of 4 years, January 2010 to December 2013. Follow-up information was available for a median of 27 months (range, 12-42 months) The commonest cause of double-duct sign was choledocholithiasis followed closely by pancreatobiliary malignancy. Patients with jaundice in the context of double-duct sign had a higher incidence of malignancy (48%). None of the anicteric patients were found to have malignancy (P = 0.002). In patients with MRCP evidence of double-duct sign, the absence of jaundice makes a malignant etiology unlikely. Conversely, in jaundiced patients, a malignant cause is much more likely. Figures from larger series are needed to support this conclusion.