In Armigeres subalbatus, 60% and 3% of the ingested Brugia pahangi microfilariae (mf) respectively migrated into the haemocoel and the thorax within 5 minutes post ingestion (p.i.). Most of the mf had migrated from the gut into the haemocoel within the first 10 minutes p.i. There was no correlation between the number of mf ingested and the migration rate though those in mosquitoes with a low mf burden tend to migrate earlier. At 24 hours p.i., 5-30% of the mf were still in the gut; 19% of these mf were immobile. At 48 hours p.i. only 2% of the mf were mobile. B. pahangi mf isolated from blood meals at 24 hours p.i., failed to develop when inoculated into Armigeres subalbatus. 54% and 73% of the mf isolated from a 24 hour old clotted blood of a B. pahangi-infected cat and fresh peripheral cat blood respectively developed into stage-1 larva. Probably mf left in the midgut at 24 hours p.i. are the young and immature worms and are physiologically incapable of penetrating the gut.
Small bowel phytobezoars are rare and almost always obstructive. There have been previously reported cases of phytobezoars in the literature, however there are few reports on radiological findings for small bowel bezoars. Barium studies characteristically show an intraluminal filling defect of variable size that is not fixed to the bowel wall with barium filling the interstices giving a mottled appearance. On CT scan, the presence of a round or ovoid intraluminal mass with a 'mottled gas' pattern is believed to be pathognomonic. Since features on CT scans are characteristics and physical findings are of little assistance in the diagnosis of bezoar, the diagnostic value of CT needs to be emphasised.
Four subpopulations of a Plutella xylostella (L.) strain from Malaysia (F(4) to F(8)) were selected with Bacillus thuringiensis subsp. kurstaki HD-1, Bacillus thuringiensis subsp. aizawai, Cry1Ab, and Cry1Ac, respectively, while a fifth subpopulation was left as unselected (UNSEL-MEL). Bioassays at F(9) found that selection with Cry1Ac, Cry1Ab, B. thuringiensis subsp. kurstaki, and B. thuringiensis subsp. aizawai gave resistance ratios of >95, 10, 7, and 3, respectively, compared with UNSEL-MEL (>10,500, 500, >100, and 26, respectively, compared with a susceptible population, ROTH). Resistance to Cry1Ac, Cry1Ab, B. thuringiensis subsp. kurstaki, and B. thuringiensis subsp. aizawai in UNSEL-MEL declined significantly by F(9). The Cry1Ac-selected population showed very little cross-resistance to Cry1Ab, B. thuringiensis subsp. kurstaki, and B. thuringiensis subsp. aizawai (5-, 1-, and 4-fold compared with UNSEL-MEL), whereas the Cry1Ab-, B. thuringiensis subsp. kurstaki-, and B. thuringiensis subsp. aizawai-selected populations showed high cross-resistance to Cry1Ac (60-, 100-, and 70-fold). The Cry1Ac-selected population was reselected (F(9) to F(13)) to give a resistance ratio of >2,400 compared with UNSEL-MEL. Binding studies with (125)I-labeled Cry1Ab and Cry1Ac revealed complete lack of binding to brush border membrane vesicles prepared from Cry1Ac-selected larvae (F(15)). Binding was also reduced, although less drastically, in the revertant population, which indicates that a modification in the common binding site of these two toxins was involved in the resistance mechanism in the original population. Reciprocal genetic crosses between Cry1Ac-reselected and ROTH insects indicated that resistance was autosomal and showed incomplete dominance. At the highest dose of Cry1Ac tested, resistance was recessive while at the lowest dose it was almost completely dominant. The F(2) progeny from a backcross of F(1) progeny with ROTH was tested with a concentration of Cry1Ac which would kill 100% of ROTH moths. Eight of the 12 families tested had 60 to 90% mortality, which indicated that more than one allele on separate loci was responsible for resistance to Cry1Ac.
To investigate the anxieties of patients undergoing oesophago-gastro-duodenoscopy (OGD), colonoscopy and endoscopic retrograde cholangio-pancreatography (ERCP) in relation to their demographic features, their knowledge and understanding of the procedure, its indication, and their doctors' explanation. A standard questionnaire was filled in consecutively for 280 OGD patients, 64 colonoscopy patients and 50 ERCP patients.
The concept of consuming microorganisms in the treatment of a medical condition and in health maintenance has gained much attraction, giving rise to an abundance of medical claims and of health supplements. This study identified relevant clinical questions on the therapeutic use of probiotics and reviewed the literature in irritable bowel syndrome, inflammatory bowel disease, impaired intestinal immunity, liver disease, intestinal infections, and common childhood digestive disorders. Statements were developed to address these clinical questions. A panel of experienced clinicians was tasked to critically evaluate and debate the available data. Both consensus and contentious statements are presented to provide to clinicians a perspective on the potential of probiotics and importantly their limitations.
Matched MeSH terms: Digestive System Diseases/therapy*
The filaria vector competence of Anopheles stephensi was compared with Brugia-susceptible Aedes aegypti Liverpool strain, An. gambiae Badagry Lagos strain and An. dirus Perlis Malaysia strain. An. stephensi ingested more Brugia pahangi microfilariae, had the highest infectivity rate and yielded more infective mosquitoes than the other two anopheline species. The overall vector competence of An. stephensi was 0.13 times that of Ae. aegypti, 0.62 times that of An. gambiae and 2.17 times that of An. dirus. However, heavy mortality among infected An. stephensi in the present investigation indicates that the filaria vectorial capacity of the mosquito might be limited epidemiologically. The relationship between filaria vector competence and mosquito foregut armature is discussed. It was observed that the relative vector competence of the three anopheline species tested was in the same order as their relative degrees of armature elaboration. The converse would be expected if foregut armatures really give partial protection to the mosquitoes against filarial infection. It is suggested that high host microfilariae density favours larval survival proportional to the degree of armature development in Anopheles (Cellia) species.
Matched MeSH terms: Digestive System/parasitology; Digestive System Physiological Phenomena
A 7-year-old, intact female Domestic Shorthair cat was referred to University Veterinary Hospital (UVH), UPM for diagnostic workup of a hepatomegaly observed on abdominal radiographs. Physical examination revealed no significant findings except for a distended abdomen. Hematology and serum biochemistry findings included a regenerative anaemia, left shift neutrophilia and a 10-fold elevation in gamma-glutamyltranspeptidase (GGT). Abdominal ultrasound revealed heterechoic liver lobes with irregular margins and presence of nodular and cyst-like structures predominantly affecting the left lobes. A mild ascites was also noted. A fine needle aspiration of the liver was performed and cytology results confirmed a cholangiocarcinoma. Generally, the outcome for cholagiocarcinoma is poor and there is limited information regarding the prognosis for patients with cholangiocarcinoma following chemotherapy or surgery.
Matched MeSH terms: Digestive System Abnormalities
Zika virus (ZIKV) is a mosquito-borne flavivirus with global impact since 2015. Although ZIKV was first isolated from Aedes aegypti in Malaysia in 1965, not much is known about the competency of Malaysian Ae. aegypti to ZIKV. To date only 9 cases of ZIKV have been reported in Malaysia despite the abundance of mosquito vectors. This study aimed to determine the susceptibility of Ae. aegypti to ZIKV, and the impact of sequential infections in Ae. aegypti mosquitoes with DENV serotype 2 (DENV-2) followed by ZIKV. Field-caught urban Ae. aegypti were orally challenged with a Martinique strain of ZIKV, and midgut, head/thorax and saliva were collected at 3, 7 and 14 days post-infection (dpi). At 14 dpi, ZIKV-exposed mosquitoes had infection and dissemination rates of 59% (n=10/17) and 90% (n=9/10), respectively. Average titres of 3.9 and 4.4 log pfu infectious ZIKV were recovered in midgut and head/thorax, respectively. In sequential infection, prior exposure of Ae. aegypti to DENV did not affect the subsequent ZIKV infection in head/thorax albeit with a low sample size. In conclusion, Malaysian urban Ae. aegypti is susceptible to the contemporary Asian lineage of ZIKV. The established and continuous DENV circulation in Ae. aegypti did not suppress ZIKV emergence in Malaysia. Other factors contributing to low level of ZIKV circulation in Malaysia remain to be explored.
Aerodigestive amyloidosis is a rare disorder characterized by fibrillar protein deposition in the aerodigestive tree. We present a case of a 19-year-old Chinese gentleman whose diagnosis was initially missed as he presented with features suggestive of severe bronchial asthma and was intubated and ventilated. He subsequently presented 2 years later with severe stridor and required emergency tracheostomy. Current literature is reviewed for the histopathology, common clinical features, radiological findings and treatment options for aerodigestive amyloidosis.
Matched MeSH terms: Digestive System Diseases/complications; Digestive System Diseases/diagnosis*; Digestive System Diseases/therapy
Pancreatic cancer is a highly lethal disease, and most patients remain asymptomatic until the disease enters advanced stages. There is lack of knowledge in the pathogenesis, effective prevention and early diagnosis of pancreatic cancer. Recently, bacteria were found in pancreatic tissue that has been considered sterile before. The distribution of flora in pancreatic cancer tissue was reported to be different from normal pancreatic tissue. These abnormally distributed bacteria may be the risk factors for inducing pancreatic cancer. Therefore, studies on combined effect of multi-bacterial and multi-virulence factors may add to the knowledge of pancreatic cancer pathogenesis and aid in designing new preventive and therapeutic strategies. In this review, we outlined three oral bacteria associated with pancreatic cancer and their virulence factors linked with cancer.
Foreign body ingestion in the majority of children is often witnessed or suspected and may present with vomiting or choking. An unusual mode of presentation with haemetemesis and maelena in a 10 month old child is described here.
The concentrations of Cu, Pb, and Zn in the crystalline style (CS) and in the remaining soft tissues (ST) of the green-lipped mussel Perna viridis from 10 geographical sites along the coastal waters off peninsular Malaysia were determined. The CS, compared with the remaining ST, accumulated higher levels of Cu in both contaminated and uncontaminated samples, indicating that the style has a higher affinity for the essential Cu to bind with metallothioneins. The similar pattern of Cu accumulation in the different ST of mussels collected from clean and Cu-contaminated sites indicated that the detoxification capacity of the metallothioneins had not been overloaded. For Pb, higher levels of the metal in the CS than in the remaining ST were found only in mussels collected from a contaminated site at Kg. Pasir Puteh. This indicated a tissue redistribution of Pb due to its binding to metallothioneins for Pb detoxification and the potential of the CS as an indicator organ of Pb bioavailability and contamination. For Zn, the above two phenomena were not found since no obvious patterns were observed (lower levels of Zn in the CS than in the remaining ST) in contaminated and uncontaminated samples due to the mechanism of partial regulation. Generally, all the different STs studied (foot, mantle, gonad, CS, gill, muscle, and byssus) are good biomonitoring tissues for Cu and Pb bioavailabilities and contamination. Among these organs, the CS was found to be the best organ for biomonitoring Cu. The present data also suggest the use of the tissue redistribution of Pb in P. viridis as an indicator of Pb bioavailability and contamination in coastal waters.
Hyperplastic polyps are the most common polypoidal lesions of the stomach showing a varied presentation. They may be asymptomatic; however, occasionally they can cause anaemia and gastric outlet obstruction. Malignant transformation is a serious complication associated with such polyps. We present the case of an elderly woman who complained of epigastric pain and intermittent vomiting. Oesophagogastroduodenoscopy (OGDS) showed a large pedunculated polyp along the lesser curvature of the stomach, 4 cm from the gastro-oesophageal junction, extending into the first part of the duodenum that caused gastric outlet obstruction. Computed tomography reported a soft-tissue mass arising from the incisura and extending through the pylorus into the duodenum (D1 and proximal D2). An endoscopic polypectomy was performed, and histopathological examination reported evidence of early gastric carcinoma. She underwent regular endoscopic follow-up with biopsies performed over 2 years, and the last follow-up showed mild-to-moderate dysplasia at the previous excision site. She underwent a planned laparoscopic wedge resection, and histopathological examination confirmed the presence of a hyperplastic polyp showing low-grade dysplasia.
Paraesophageal hernias have been historically associated with risk of substantial morbidity and mortality. We report a case of a 92 year old lady with acute gastric outlet obstruction due to a chronic paraesophageal hernia that was successfully treated by minimal invasive surgery. Anterior gastropexy was performed after the stomach was reduced. The hiatal opening was enlarged to reduce the risk of obstruction in the future. She was discharged well on the third day.
Matched MeSH terms: Digestive System Surgical Procedures/methods
This Guideline is a joint official statement of the Asian Pacific Association of Gastroenterology (APAGE) and the Asian Pacific Society for Digestive Endoscopy (APSDE). It was developed in response to the increasing use of antithrombotic agents (antiplatelet agents and anticoagulants) in patients undergoing gastrointestinal (GI) endoscopy in Asia. After reviewing current practice guidelines in Europe and the USA, the joint committee identified unmet needs, noticed inconsistencies, raised doubts about certain recommendations and recognised significant discrepancies in clinical practice between different regions. We developed this joint official statement based on a systematic review of the literature, critical appraisal of existing guidelines and expert consensus using a two-stage modified Delphi process. This joint APAGE-APSDE Practice Guideline is intended to be an educational tool that assists clinicians in improving care for patients on antithrombotics who require emergency or elective GI endoscopy in the Asian Pacific region.
Robotic surgery is a technique that uses mechanical, computercontrolled arms to conduct surgical operations. It carries the advantages of minimal access associated with laparoscopic surgery, and of precision associated with open surgery. It is also feasible to conduct robotic surgery with the surgeon far away, by “telerobotics”. The robot is more versatile than the human arm, and less susceptible to tremors. The view is excellent, and it is possible to conduct more intricate procedures than are possible with the human hand. Robotics has been in use for over seven years, and the initial experience shows that the success rate is over 90%, with only about 10% of cases needing to be converted to open surgery. Blood loss is low, and tumour margins in cancer surgery are satisfactory. Surgeons have used robotics for procedures in urology, gastrointestinal surgery, gynecology, cardiac surgery, neurosurgery, orthopedics, and other specialties. Presently, robotics suffers from two major disadvantages: one, that it is very expensive, and two, that robotic procedures take significantly longer than do open or laparoscopic procedures.
Matched MeSH terms: Digestive System Surgical Procedures
This 10-year review of surgical conditions in infants at the University Hospital, Kuala Lumpur, highlights some of the more common problems encountered and outlines their management. Anorectal agenesis and Hirschsprung's disease were seen relatively more frequently than other anomalies of the gastrointestinal tract. The management of these two conditions and the operation of colostomy and its complications are singled out and presented in some detail.
Matched MeSH terms: Digestive System Abnormalities; Digestive System Surgical Procedures*