Rafiz Abdul Rani | Universiti Teknologi Mara (original) (raw)

Papers by Rafiz Abdul Rani

Research paper thumbnail of WED-321 Association between psoriasis severity and steatosis measured by artificial Intelligence-based algorithm (LIVERFASt)

Journal of hepatology, Jun 1, 2024

Research paper thumbnail of Learning Curve in Esophageal Endoscopic Submucosal Dissection by Western Endoscospists Trained in Japan: Experience in Latin America

Arquivos De Gastroenterologia, Jun 1, 2023

Research paper thumbnail of Irritable bowel syndrome and inflammatory bowel disease overlap syndrome: pieces of the puzzle are falling into place

Intestinal Research, 2016

Research paper thumbnail of Endoscopic findings among geriatric patients with anaemia and chronic kidney disease at a tertiary teaching hospital in Malaysia

The Medical journal of Malaysia, May 1, 2022

Research paper thumbnail of Clinical assessment and cytokines level in constipation-predominant irritable bowel syndrome participants treated with Lactobacillus-containing cultured milk drink

Acta Gastro Enterologica Belgica, 2021

Gut dysbiosis is linked with the pathophysiology of irritable bowel syndrome (IBS). Manipulation ... more Gut dysbiosis is linked with the pathophysiology of irritable bowel syndrome (IBS). Manipulation of intestinal microbiota using cultured milk drinks may stimulate the immune system, hence providing beneficial support in IBS treatment. This study aimed to investigate the effects of cultured milk drink on clinical symptoms, intestinal transit time (ITT), fecal pH and cytokines in constipation- predominant IBS (IBS-C) as compared to non-IBS participants. Each recruited participant was given three bottles of 125 ml cultured milk drink containing 10 9 cfu Lactobacillus acidophilus LA-5 and Lactobacillus paracasei L. CASEI-01 consumed daily for 30 days. At pre- and post-30-day consumption, fecal pH, ITT, clinical symptoms, IL-6, IL-8 and TNF-α levels were assessed. Seventy- seven IBS-C and 88 non-IBS were enrolled. Post-consumption, 97.4% of IBS-C experienced improvements in constipation- related symptoms supported by the significant reduction of ITT and decreased fecal pH (p<0.05). Al...

Research paper thumbnail of Polyps! Polyps! And More Polyps! - The First Case of Cronkhite-Canada Syndrome in Malaysia

The Medical journal of Malaysia, Feb 1, 2016

Cronkhite-Canada Syndrome (CCS) is a syndrome characterised by a constellation of signs including... more Cronkhite-Canada Syndrome (CCS) is a syndrome characterised by a constellation of signs including but not limited to onychodystrophy of the finger and toe nails, skin hyperpigmentation and alopecia. Endoscopic features showed hamartomatous polyps involving all segments of the gastrointestinal tract with the characteristic exception of being oesophageal sparring. These polyps show confirmation by the presence of eosinophils and mast cells at the lamina propria upon histological studies.

Research paper thumbnail of Review and expert opinion on MAFLD, oxidative stress and multifunctional management

Drugs in context, Jan 9, 2024

Research paper thumbnail of 122 Therapeutic Results of Precutting Emr for Lesions 10-30MM in Size

Gastrointestinal Endoscopy

Research paper thumbnail of Magnifying Endoscopy: Image-Enhanced Endoscopy Focused on JNET Classification—Blue Laser Imaging (BLI)

Endoscopic Management of Colorectal T1(SM) Carcinoma

Blue laser imaging (BLI) (Fujifilm Co., Tokyo, Japan) is made from two types of lasers with wavel... more Blue laser imaging (BLI) (Fujifilm Co., Tokyo, Japan) is made from two types of lasers with wavelengths of 410 and 450 nm. BLI is a kind of narrow-band light observations. This mode enables us to observe the detailed surface pattern and vessel pattern for diagnosing JNET classifications for colorectal lesions. Although it is originally performed with NBI, the JNET classification can be used with BLI in similar to NBI; we previously demonstrated the high consistency in the findings of NBI and BLI magnification. Typical T1b cancers show loose vascular area and amorphous surface pattern. In those tumors, surface structure seems destroyed. However, some T1b cancers remain surface structures and show irregular vessel pattern and surface pattern. In this paper, we review the efficacies of BLI magnification for T1 cancers.

Research paper thumbnail of Recurrence rate and lesions characteristics after cold snare polypectomy of high-grade dysplasia and T1 lesions - a multicenter analysis

Journal of gastroenterology and hepatology, 2021

BACKGROUND AND AIM High-grade dysplasia (HGD) and T1 lesions are accidentally resected by cold sn... more BACKGROUND AND AIM High-grade dysplasia (HGD) and T1 lesions are accidentally resected by cold snare polypectomy (CSP) and the characteristics and follow-up of them has not been reported. In this study, we analyzed the histopathological findings and recurrence of them. METHODS This was a multicenter retrospective-cohort study. We collected HGD and T1 lesions of ≤10 mm resected by CSP among 15520 patients receiving CSP from 2014 to 2019 at 9 related institutions and we extracted only cases receiving definite follow-up colonoscopy after CSP of HGD and T1 lesions. We analyzed these tumor's characteristics and therapeutic results such as R0 resection and local recurrence, and, risk factors of recurrence. RESULTS We collected 103 patients (0.63%) and extracted 80 lesions in 74 patients receiving follow-up colonoscopy for CSP scar. Mean age was 68.4±12.0, and male rate was 68.9% (51/80). The mean tumor size (mm) was 6.6±2.5, and the rate of polypoid morphology and rectum location was ...

Research paper thumbnail of Abdominal wall necrotising fasciitis: A rare but devastating complication of the percutaneous endoscopic gastrostomy procedure

Percutaneous Endoscopic Gastrostomy (PEG) tubes were often offered to patients requiring long ter... more Percutaneous Endoscopic Gastrostomy (PEG) tubes were often offered to patients requiring long term enteral feeding. Even though the procedure is relatively safe, it is associated with various complications such as peritonitis or even death.1 We presented a case of a 54-year-old gentleman with underlying ischemic stroke and pus discharges from a recently inserted PEG tube. Computed Topography (CT) scan confirmed abdominal wall necrotising fasciitis complicated with hyperosmolar hyperglycaemia state (HHS) and later succumbed after 48 hours of admission. Our case illustrated the rare complication related to the insertion of PEG tube; abdominal wall necrotising fasciitis that was associated with mortality.

Research paper thumbnail of Suicidal ideation amongst epilepsy patients in a tertiary centre

Background and Objective: Epilepsy and depression are interlinked and lead to an increased risk o... more Background and Objective: Epilepsy and depression are interlinked and lead to an increased risk of suicidal ideation and suicide. Although depression is a significant risk factor for suicidal ideation in epilepsy patients, epilepsy itself is independently associated with suicidal ideation. There are various other factors related to epilepsy that further increase this risk. Methods: We conducted a study of suicidal-ideation amongst epilepsy patients in our centre. Demographic data and clinical history were obtained while suicidal ideation was determined using the Columbia Suicide Severity Rating Scale (C-SSRS). Beck’s Depression Inventory–II (BDI-II) was used to identify presence of depression. Results: We recruited 80 patients with epilepsy and an equal number of controls. Epilepsy patients were more likely to be depressed with a mean BDI-II score of 9.09 ±6.48 compared to controls who has a mean score of 5.56 ±4.56. The proportion of epilepsy patients with suicidal ideation was 33....

Research paper thumbnail of Magnifying Endoscopy: Image-Enhanced Endoscopy Focused on JNET Classification—Blue Laser Imaging (BLI)

Blue laser imaging (BLI) (Fujifilm Co., Tokyo, Japan) is made from two types of lasers with wavel... more Blue laser imaging (BLI) (Fujifilm Co., Tokyo, Japan) is made from two types of lasers with wavelengths of 410 and 450 nm. BLI is a kind of narrow-band light observations. This mode enables us to observe the detailed surface pattern and vessel pattern for diagnosing JNET classifications for colorectal lesions. Although it is originally performed with NBI, the JNET classification can be used with BLI in similar to NBI; we previously demonstrated the high consistency in the findings of NBI and BLI magnification. Typical T1b cancers show loose vascular area and amorphous surface pattern. In those tumors, surface structure seems destroyed. However, some T1b cancers remain surface structures and show irregular vessel pattern and surface pattern. In this paper, we review the efficacies of BLI magnification for T1 cancers.

Research paper thumbnail of The effects of different postures and provocative swallow materials on the normative Chicago 3.0 metrics in a healthy Asian population

Journal of Gastroenterology and Hepatology, 2020

Variations in the Chicago 3.0 normative metrics may exist with different postures and with differ... more Variations in the Chicago 3.0 normative metrics may exist with different postures and with different provocative swallow materials in a healthy Asian population.

Research paper thumbnail of 122 Therapeutic Results of Precutting Emr for Lesions 10-30MM in Size

Gastrointestinal Endoscopy, 2018

Research paper thumbnail of Sa1931 IMPROVEMENT OF POLYP DETECTION RATE WITH 30 SECONDS ADDITIONAL RIGHT-SIDED COLON OBSERVATION USING LINKED COLOR IMAGING

Research paper thumbnail of A Diminutive T1 Cancer 4 mm in Size Resected by Cold Snare Polypectomy

Case Reports in Gastroenterology

Cold snare polypectomy (CSP) should be performed for benign lesions, though an accurate diagnosis... more Cold snare polypectomy (CSP) should be performed for benign lesions, though an accurate diagnosis is sometimes difficult with only white light observation. Irregular findings by narrow-band imaging (NBI) are useful for differentiating malignant lesions from benign lesions, and cases with this finding are not expected for CSP. We present a diminutive T1 cancer resected by CSP as a reflection case. A 68-year-old man underwent colonoscopy for surveillance after polypectomy. A reddish polyp 4 mm in size was detected at the rectum. White light observation showed no depression, but a slight, heterogeneous color change. NBI magnification showed irregular vessel and surface patterns. The polyp was diagnosed as intramucosal cancer. Even though cancerous lesions are regularly resected by endoscopic mucosal resection (EMR), this polyp was resected by CSP in daycare surgery because the patient requested not to be treated by EMR but by CSP, which needed an admission to our institution. The surge...

Research paper thumbnail of A case of urgent colonoscopic hemostasis of a cecal hemorrhagic ulceration in a patient receiving heparin for COVID ‐19 coagulopathy

JGH Open

COVID‐19 rarely causes lower gastrointestinal bleeding even though its RNA has been detected in p... more COVID‐19 rarely causes lower gastrointestinal bleeding even though its RNA has been detected in patient's stool. Urgent colonoscopy in a COVID‐19 patient with massive bloody stool requires various procedural and equipment considerations. Here, we present a case of colonoscopic hemostasis of a cecal hemorrhagic ulceration in a patient on heparin for COVID‐19 coagulopathy. We also share various management methods for the prevention of COVID‐19 contamination. A 71‐year‐old man was diagnosed with COVID‐19 pneumonia and subsequently underwent hemodiafiltration. Heparin was initiated for COVID‐19 coagulopathy. At day 42, the patient experienced 2000 mL of bloody stool. An operator performed urgent colonoscopy with three assistants in a negative‐pressure room with full personal protective equipment. A hemorrhagic ulceration was detected at the cecum, and endoscopic hemostasis was performed. Immunohistochemistry was positive for cytomegalovirus. Postprocedure, the endoscopic systems were thoroughly cleaned, and specific measures for endoscope reprocessing and disinfection were performed to prevent contamination with COVID‐19.

Research paper thumbnail of Histopathologic Diagnosis Discrepancies Between Preoperative Endoscopic Forceps Biopsies and Specimens Resected by Endoscopic Submucosal Dissection in Superficial Gastric Neoplasms

Journal of Clinical Gastroenterology

BACKGROUND The standard of practice when a superficial lesion was identified during upper GI endo... more BACKGROUND The standard of practice when a superficial lesion was identified during upper GI endoscopy is to take an endoscopic forceps biopsy (EFB) of the lesion. The histopathologic findings then will determine the management plan. Endoscopic submucosal dissection (ESD) enables en-bloc resection for early neoplasms of the gastrointestinal tract and provides an adequate specimen that permits a more reliable histopathologic assessment. The objective of this study was to determine the rate of histopathologic discrepancy between EFB and specimens resected by ESD, and to identify the predisposing risk factors for this discordance. MATERIALS AND METHODS This is a retrospective study, enrolling patients with superficial gastric neoplasms that underwent EFB followed by ESD. We divided cases to concordant or discordant group according to the histopathologic diagnosis of EFB and ESD specimens. We also analyzed the features that may have influenced the occurrence of histopathologic discordance and the association between discordant samples of adenocarcinoma and neoplastic invasion to deeper layers. RESULTS A total of 115 gastric ESD procedures were performed with 84 patients meeting the inclusion criteria. Histopathologic discordance between EFB and ESD specimens were observed in 35.8% of cases (30/84 lesions). The univariant-bivariant analysis and multivariate logistic regression analysis showed that histologic discordance was closely related to the size of the lesions (P=0.028). CONCLUSION Histopathologic discrepancy between EFB and ESD specimens may occur in approximately one-third of cases, particularly for lesions over 20 mm, which may lead to crucial delays in gastric cancer precise diagnosis and treatment.

Research paper thumbnail of Prevalence of Subthreshold Depression Among Constipation-Predominant Irritable Bowel Syndrome Patients

Frontiers in Psychology

Patients suffering from irritable bowel syndrome (IBS) may have some form of affective disorders ... more Patients suffering from irritable bowel syndrome (IBS) may have some form of affective disorders that may worsen their symptoms. Lack of screening among IBS patients is one of the reasons for depression unawareness among healthcare providers. The present study was conducted to evaluate the prevalence of depression among patients with constipation-predominant IBS (IBS-C). A total of 240 IBS patients who fulfilled Rome III criteria were enrolled. The psychiatric assessment was evaluated using the Center for Epidemiologic Studies Depression Scale Revised (CESD-R). Twenty items in CESD-R scale measured symptoms of depression in nine separate groups. Patients were categorized into five different subgroups: major depressive episode, probable major depressive episode, possible major depressive episode, subthreshold depressive symptoms, and without clinical significance of depression. Out of the 240 patients with IBS-C, the majority (n = 161, 67.1%) had no clinical significance of depression. Seventy seven (32.1%) had subthreshold depression and only two (0.83%) patients were regarded as having probable a major depressive episode. No patient was categorized into a major or possible major depressive episode. The prevalence of subthreshold depression was the highest among female (72.3%) patients with 51.1% being single, 44.7% were married, and 4.3% were divorcees. When stratified according to ethnicity, subthreshold depression was highly prevalent among Malays (76.6%), followed by Chinese (19.2%), and Indians (2.1%). A high percentage of the patients were found to be non-smokers (93.6%) and had lower income of less than RM 5000 (USD 1250) per month (89.4%). The moderately high prevalence of subthreshold depression among patients with IBS, justifies psychological evaluation in all patients with functional gastrointestinal disorders.

Research paper thumbnail of WED-321 Association between psoriasis severity and steatosis measured by artificial Intelligence-based algorithm (LIVERFASt)

Journal of hepatology, Jun 1, 2024

Research paper thumbnail of Learning Curve in Esophageal Endoscopic Submucosal Dissection by Western Endoscospists Trained in Japan: Experience in Latin America

Arquivos De Gastroenterologia, Jun 1, 2023

Research paper thumbnail of Irritable bowel syndrome and inflammatory bowel disease overlap syndrome: pieces of the puzzle are falling into place

Intestinal Research, 2016

Research paper thumbnail of Endoscopic findings among geriatric patients with anaemia and chronic kidney disease at a tertiary teaching hospital in Malaysia

The Medical journal of Malaysia, May 1, 2022

Research paper thumbnail of Clinical assessment and cytokines level in constipation-predominant irritable bowel syndrome participants treated with Lactobacillus-containing cultured milk drink

Acta Gastro Enterologica Belgica, 2021

Gut dysbiosis is linked with the pathophysiology of irritable bowel syndrome (IBS). Manipulation ... more Gut dysbiosis is linked with the pathophysiology of irritable bowel syndrome (IBS). Manipulation of intestinal microbiota using cultured milk drinks may stimulate the immune system, hence providing beneficial support in IBS treatment. This study aimed to investigate the effects of cultured milk drink on clinical symptoms, intestinal transit time (ITT), fecal pH and cytokines in constipation- predominant IBS (IBS-C) as compared to non-IBS participants. Each recruited participant was given three bottles of 125 ml cultured milk drink containing 10 9 cfu Lactobacillus acidophilus LA-5 and Lactobacillus paracasei L. CASEI-01 consumed daily for 30 days. At pre- and post-30-day consumption, fecal pH, ITT, clinical symptoms, IL-6, IL-8 and TNF-α levels were assessed. Seventy- seven IBS-C and 88 non-IBS were enrolled. Post-consumption, 97.4% of IBS-C experienced improvements in constipation- related symptoms supported by the significant reduction of ITT and decreased fecal pH (p<0.05). Al...

Research paper thumbnail of Polyps! Polyps! And More Polyps! - The First Case of Cronkhite-Canada Syndrome in Malaysia

The Medical journal of Malaysia, Feb 1, 2016

Cronkhite-Canada Syndrome (CCS) is a syndrome characterised by a constellation of signs including... more Cronkhite-Canada Syndrome (CCS) is a syndrome characterised by a constellation of signs including but not limited to onychodystrophy of the finger and toe nails, skin hyperpigmentation and alopecia. Endoscopic features showed hamartomatous polyps involving all segments of the gastrointestinal tract with the characteristic exception of being oesophageal sparring. These polyps show confirmation by the presence of eosinophils and mast cells at the lamina propria upon histological studies.

Research paper thumbnail of Review and expert opinion on MAFLD, oxidative stress and multifunctional management

Drugs in context, Jan 9, 2024

Research paper thumbnail of 122 Therapeutic Results of Precutting Emr for Lesions 10-30MM in Size

Gastrointestinal Endoscopy

Research paper thumbnail of Magnifying Endoscopy: Image-Enhanced Endoscopy Focused on JNET Classification—Blue Laser Imaging (BLI)

Endoscopic Management of Colorectal T1(SM) Carcinoma

Blue laser imaging (BLI) (Fujifilm Co., Tokyo, Japan) is made from two types of lasers with wavel... more Blue laser imaging (BLI) (Fujifilm Co., Tokyo, Japan) is made from two types of lasers with wavelengths of 410 and 450 nm. BLI is a kind of narrow-band light observations. This mode enables us to observe the detailed surface pattern and vessel pattern for diagnosing JNET classifications for colorectal lesions. Although it is originally performed with NBI, the JNET classification can be used with BLI in similar to NBI; we previously demonstrated the high consistency in the findings of NBI and BLI magnification. Typical T1b cancers show loose vascular area and amorphous surface pattern. In those tumors, surface structure seems destroyed. However, some T1b cancers remain surface structures and show irregular vessel pattern and surface pattern. In this paper, we review the efficacies of BLI magnification for T1 cancers.

Research paper thumbnail of Recurrence rate and lesions characteristics after cold snare polypectomy of high-grade dysplasia and T1 lesions - a multicenter analysis

Journal of gastroenterology and hepatology, 2021

BACKGROUND AND AIM High-grade dysplasia (HGD) and T1 lesions are accidentally resected by cold sn... more BACKGROUND AND AIM High-grade dysplasia (HGD) and T1 lesions are accidentally resected by cold snare polypectomy (CSP) and the characteristics and follow-up of them has not been reported. In this study, we analyzed the histopathological findings and recurrence of them. METHODS This was a multicenter retrospective-cohort study. We collected HGD and T1 lesions of ≤10 mm resected by CSP among 15520 patients receiving CSP from 2014 to 2019 at 9 related institutions and we extracted only cases receiving definite follow-up colonoscopy after CSP of HGD and T1 lesions. We analyzed these tumor's characteristics and therapeutic results such as R0 resection and local recurrence, and, risk factors of recurrence. RESULTS We collected 103 patients (0.63%) and extracted 80 lesions in 74 patients receiving follow-up colonoscopy for CSP scar. Mean age was 68.4±12.0, and male rate was 68.9% (51/80). The mean tumor size (mm) was 6.6±2.5, and the rate of polypoid morphology and rectum location was ...

Research paper thumbnail of Abdominal wall necrotising fasciitis: A rare but devastating complication of the percutaneous endoscopic gastrostomy procedure

Percutaneous Endoscopic Gastrostomy (PEG) tubes were often offered to patients requiring long ter... more Percutaneous Endoscopic Gastrostomy (PEG) tubes were often offered to patients requiring long term enteral feeding. Even though the procedure is relatively safe, it is associated with various complications such as peritonitis or even death.1 We presented a case of a 54-year-old gentleman with underlying ischemic stroke and pus discharges from a recently inserted PEG tube. Computed Topography (CT) scan confirmed abdominal wall necrotising fasciitis complicated with hyperosmolar hyperglycaemia state (HHS) and later succumbed after 48 hours of admission. Our case illustrated the rare complication related to the insertion of PEG tube; abdominal wall necrotising fasciitis that was associated with mortality.

Research paper thumbnail of Suicidal ideation amongst epilepsy patients in a tertiary centre

Background and Objective: Epilepsy and depression are interlinked and lead to an increased risk o... more Background and Objective: Epilepsy and depression are interlinked and lead to an increased risk of suicidal ideation and suicide. Although depression is a significant risk factor for suicidal ideation in epilepsy patients, epilepsy itself is independently associated with suicidal ideation. There are various other factors related to epilepsy that further increase this risk. Methods: We conducted a study of suicidal-ideation amongst epilepsy patients in our centre. Demographic data and clinical history were obtained while suicidal ideation was determined using the Columbia Suicide Severity Rating Scale (C-SSRS). Beck’s Depression Inventory–II (BDI-II) was used to identify presence of depression. Results: We recruited 80 patients with epilepsy and an equal number of controls. Epilepsy patients were more likely to be depressed with a mean BDI-II score of 9.09 ±6.48 compared to controls who has a mean score of 5.56 ±4.56. The proportion of epilepsy patients with suicidal ideation was 33....

Research paper thumbnail of Magnifying Endoscopy: Image-Enhanced Endoscopy Focused on JNET Classification—Blue Laser Imaging (BLI)

Blue laser imaging (BLI) (Fujifilm Co., Tokyo, Japan) is made from two types of lasers with wavel... more Blue laser imaging (BLI) (Fujifilm Co., Tokyo, Japan) is made from two types of lasers with wavelengths of 410 and 450 nm. BLI is a kind of narrow-band light observations. This mode enables us to observe the detailed surface pattern and vessel pattern for diagnosing JNET classifications for colorectal lesions. Although it is originally performed with NBI, the JNET classification can be used with BLI in similar to NBI; we previously demonstrated the high consistency in the findings of NBI and BLI magnification. Typical T1b cancers show loose vascular area and amorphous surface pattern. In those tumors, surface structure seems destroyed. However, some T1b cancers remain surface structures and show irregular vessel pattern and surface pattern. In this paper, we review the efficacies of BLI magnification for T1 cancers.

Research paper thumbnail of The effects of different postures and provocative swallow materials on the normative Chicago 3.0 metrics in a healthy Asian population

Journal of Gastroenterology and Hepatology, 2020

Variations in the Chicago 3.0 normative metrics may exist with different postures and with differ... more Variations in the Chicago 3.0 normative metrics may exist with different postures and with different provocative swallow materials in a healthy Asian population.

Research paper thumbnail of 122 Therapeutic Results of Precutting Emr for Lesions 10-30MM in Size

Gastrointestinal Endoscopy, 2018

Research paper thumbnail of Sa1931 IMPROVEMENT OF POLYP DETECTION RATE WITH 30 SECONDS ADDITIONAL RIGHT-SIDED COLON OBSERVATION USING LINKED COLOR IMAGING

Research paper thumbnail of A Diminutive T1 Cancer 4 mm in Size Resected by Cold Snare Polypectomy

Case Reports in Gastroenterology

Cold snare polypectomy (CSP) should be performed for benign lesions, though an accurate diagnosis... more Cold snare polypectomy (CSP) should be performed for benign lesions, though an accurate diagnosis is sometimes difficult with only white light observation. Irregular findings by narrow-band imaging (NBI) are useful for differentiating malignant lesions from benign lesions, and cases with this finding are not expected for CSP. We present a diminutive T1 cancer resected by CSP as a reflection case. A 68-year-old man underwent colonoscopy for surveillance after polypectomy. A reddish polyp 4 mm in size was detected at the rectum. White light observation showed no depression, but a slight, heterogeneous color change. NBI magnification showed irregular vessel and surface patterns. The polyp was diagnosed as intramucosal cancer. Even though cancerous lesions are regularly resected by endoscopic mucosal resection (EMR), this polyp was resected by CSP in daycare surgery because the patient requested not to be treated by EMR but by CSP, which needed an admission to our institution. The surge...

Research paper thumbnail of A case of urgent colonoscopic hemostasis of a cecal hemorrhagic ulceration in a patient receiving heparin for COVID ‐19 coagulopathy

JGH Open

COVID‐19 rarely causes lower gastrointestinal bleeding even though its RNA has been detected in p... more COVID‐19 rarely causes lower gastrointestinal bleeding even though its RNA has been detected in patient's stool. Urgent colonoscopy in a COVID‐19 patient with massive bloody stool requires various procedural and equipment considerations. Here, we present a case of colonoscopic hemostasis of a cecal hemorrhagic ulceration in a patient on heparin for COVID‐19 coagulopathy. We also share various management methods for the prevention of COVID‐19 contamination. A 71‐year‐old man was diagnosed with COVID‐19 pneumonia and subsequently underwent hemodiafiltration. Heparin was initiated for COVID‐19 coagulopathy. At day 42, the patient experienced 2000 mL of bloody stool. An operator performed urgent colonoscopy with three assistants in a negative‐pressure room with full personal protective equipment. A hemorrhagic ulceration was detected at the cecum, and endoscopic hemostasis was performed. Immunohistochemistry was positive for cytomegalovirus. Postprocedure, the endoscopic systems were thoroughly cleaned, and specific measures for endoscope reprocessing and disinfection were performed to prevent contamination with COVID‐19.

Research paper thumbnail of Histopathologic Diagnosis Discrepancies Between Preoperative Endoscopic Forceps Biopsies and Specimens Resected by Endoscopic Submucosal Dissection in Superficial Gastric Neoplasms

Journal of Clinical Gastroenterology

BACKGROUND The standard of practice when a superficial lesion was identified during upper GI endo... more BACKGROUND The standard of practice when a superficial lesion was identified during upper GI endoscopy is to take an endoscopic forceps biopsy (EFB) of the lesion. The histopathologic findings then will determine the management plan. Endoscopic submucosal dissection (ESD) enables en-bloc resection for early neoplasms of the gastrointestinal tract and provides an adequate specimen that permits a more reliable histopathologic assessment. The objective of this study was to determine the rate of histopathologic discrepancy between EFB and specimens resected by ESD, and to identify the predisposing risk factors for this discordance. MATERIALS AND METHODS This is a retrospective study, enrolling patients with superficial gastric neoplasms that underwent EFB followed by ESD. We divided cases to concordant or discordant group according to the histopathologic diagnosis of EFB and ESD specimens. We also analyzed the features that may have influenced the occurrence of histopathologic discordance and the association between discordant samples of adenocarcinoma and neoplastic invasion to deeper layers. RESULTS A total of 115 gastric ESD procedures were performed with 84 patients meeting the inclusion criteria. Histopathologic discordance between EFB and ESD specimens were observed in 35.8% of cases (30/84 lesions). The univariant-bivariant analysis and multivariate logistic regression analysis showed that histologic discordance was closely related to the size of the lesions (P=0.028). CONCLUSION Histopathologic discrepancy between EFB and ESD specimens may occur in approximately one-third of cases, particularly for lesions over 20 mm, which may lead to crucial delays in gastric cancer precise diagnosis and treatment.

Research paper thumbnail of Prevalence of Subthreshold Depression Among Constipation-Predominant Irritable Bowel Syndrome Patients

Frontiers in Psychology

Patients suffering from irritable bowel syndrome (IBS) may have some form of affective disorders ... more Patients suffering from irritable bowel syndrome (IBS) may have some form of affective disorders that may worsen their symptoms. Lack of screening among IBS patients is one of the reasons for depression unawareness among healthcare providers. The present study was conducted to evaluate the prevalence of depression among patients with constipation-predominant IBS (IBS-C). A total of 240 IBS patients who fulfilled Rome III criteria were enrolled. The psychiatric assessment was evaluated using the Center for Epidemiologic Studies Depression Scale Revised (CESD-R). Twenty items in CESD-R scale measured symptoms of depression in nine separate groups. Patients were categorized into five different subgroups: major depressive episode, probable major depressive episode, possible major depressive episode, subthreshold depressive symptoms, and without clinical significance of depression. Out of the 240 patients with IBS-C, the majority (n = 161, 67.1%) had no clinical significance of depression. Seventy seven (32.1%) had subthreshold depression and only two (0.83%) patients were regarded as having probable a major depressive episode. No patient was categorized into a major or possible major depressive episode. The prevalence of subthreshold depression was the highest among female (72.3%) patients with 51.1% being single, 44.7% were married, and 4.3% were divorcees. When stratified according to ethnicity, subthreshold depression was highly prevalent among Malays (76.6%), followed by Chinese (19.2%), and Indians (2.1%). A high percentage of the patients were found to be non-smokers (93.6%) and had lower income of less than RM 5000 (USD 1250) per month (89.4%). The moderately high prevalence of subthreshold depression among patients with IBS, justifies psychological evaluation in all patients with functional gastrointestinal disorders.