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Fulltext Sodium valproate induced necrotising pancreatitis: A case report

Ali MF, Loh KY

Malays Fam Physician, 2013;8(3):28-30.
PMID: 25893054 MyJurnal

Sodium valproate is one of the most common first-line antiepileptics prescribed for primary and secondary generalised seizures. However, serious complications associated with sodium valproate, such as acute pancreatitis, need to be considered when choosing this medication for treating epilepsy in certain populations such as children and persons with intellectual disability. We report a case of a 21-year-old man with intellectual disability who presented to the emergency department with an acute abdomen, vomiting and diarrhoea. He had to undergo an emergency exploratory laparotomy during which acute necrotising pancreatitis was diagnosed intra-operatively. We believe that the recent increase in sodium valproate dosage for his epilepsy was the cause of the pancreatitis. Carers of such persons should be adequately informed regarding possible life-threatening complications of medications prescribed to avoid delay in diagnosis and unwanted incidents.

Matched MeSH terms: Vomiting
Fulltext A fatal case of metformin and gliclazide poisoning and its management

Low, Qin Jian, Chew, Soo Foong

Borneo Journal of Medical Sciences, 2017;11(3):35-40.
MyJurnal

Both metformin and gliclazide have been used extensively in the management of type II diabetes mellitus. Metformin and gliclazide overdose can lead to severe hypoglycaemia refractory to intravenous (IV) dextrose rescue therapy. A 21-year-old man complained of vomiting and felt dizzy after four hours of taking 70 tablets of Metformin 500 mg and 40 tablets of Gliclazide 80 mg. He had major depressive disorder and wanted to commit suicide. He was given IV Dextrose 50% 50 cc immediately. Octreotide had been used successfully to reverse the refractory hypoglycaemia caused by gliclazide overdose. Unfortunately, he developed severe lactic acidosis with acute kidney injury. Dialysis had been done by continuous venovenous haemodiafiltrationa and intravenous sodium bicarbonate 8.4% infusion was given. However, the patient succumbed due to the severe lactic acidosis and kidney failure despite of urgent dialysis. Octreotide infusion helps in preventing refractory hypoglycaemia secondary to sulfonylurea overdose by inhibit calcium-mediated insulin release. Metformin overdose causes severe lactic acidosis due to conversion of glucose to lactate. Sodium bicarbonate therapy in metformin induced lactic acidosis is also controversial. Though sulfonylurea and metformin are the most commonly-prescribed anti-hypoglycaemic agents, thus during prescribing everyone has to be careful about the overdoses and side effects of these drugs.

Matched MeSH terms: Vomiting
Rome Foundation-Asian working team report: Asian functional gastrointestinal disorder symptom clusters

Siah KTH, Gong X, Yang XJ, Whitehead WE, Chen M, Hou X, et al.

Gut, 2018 Jun;67(6):1071-1077.
PMID: 28592440 DOI: 10.1136/gutjnl-2016-312852

OBJECTIVE: Functional gastrointestinal disorders (FGIDs) are diagnosed by the presence of a characteristic set of symptoms. However, the current criteria-based diagnostic approach is to some extent subjective and largely derived from observations in English-speaking Western patients. We aimed to identify latent symptom clusters in Asian patients with FGID.
DESIGN: 1805 consecutive unselected patients with FGID who presented for primary or secondary care to 11 centres across Asia completed a cultural and linguistic adaptation of the Rome III Diagnostic Questionnaire that was translated to the local languages. Principal components factor analysis with varimax rotation was used to identify symptom clusters.
RESULTS: Nine symptom clusters were identified, consisting of two oesophageal factors (F6: globus, odynophagia and dysphagia; F9: chest pain and heartburn), two gastroduodenal factors (F5: bloating, fullness, belching and flatulence; F8 regurgitation, nausea and vomiting), three bowel factors (F2: abdominal pain and diarrhoea; F3: meal-related bowel symptoms; F7: upper abdominal pain and constipation) and two anorectal factors (F1: anorectal pain and constipation; F4: diarrhoea, urgency and incontinence).
CONCLUSION: We found that the broad categorisation used both in clinical practice and in the Rome system, that is, broad anatomical divisions, and certain diagnoses with long historical records, that is, IBS with diarrhoea, and chronic constipation, are still valid in our Asian societies. In addition, we found a bowel symptom cluster with meal trigger and a gas cluster that suggests a different emphasis in our populations. Future studies to compare a non-Asian cohort and to match to putative pathophysiology will help to verify our findings.

Matched MeSH terms: Vomiting
Fulltext Post dental extraction basal skull osteomyelitis with cranial nerve palsy

Tan, Ciang Sang, Haiza Hani Hamidon, Zainah Shaikh Hedra

Malaysian Journal of Paediatrics and Child Health, 2016;22(101):0-0.
MyJurnal

Background: A 9 year old boy presented with history of persistent headache and recurrent vomiting for 1 month post dental extraction. CT brain was performed for the possibility of space occupying lesion but it was normal. Subsequently, he was treated as migraine after exclusion of meningitis and intracranial lesion. Unfortunately, he developed 3rd, 4th and 6th cranial nerve palsy two weeks later. Repeated CT brain showed subtle finding and inconclusive. MRI brain performed at the time showed features suggestive of basal skull osteomyelitis with congestion of right orbit and optic nerve swelling. Case was referred to Paediatric Neurologist and he was diagnosed to have cranial nerve palsy secondary to basal skull osteomyelitis, post dental extraction.

Conclusion: Dental procedure is common among children, however basal skull osteomyelitis with cranial nerve palsy is a rare complication. Adequate treatment of dental infection post dental procedure is important to prevent this complication.

Matched MeSH terms: Vomiting
Fulltext Isolation and characterization of a 2,4-dinitrophenol-degrading bacterium

Noor Suffiah Md. Zin, Siti Nadzirah Padrilah, Mohd Fadhil Abd. Rahman, Koh, Sim Han, Ariff Khalid, Mohd. Yunus Shukor

Bioremediation Science and Technology Research, 2016;4(2):28-33.
MyJurnal

2,4-dinitrophenol (2,4-DNP) is utilized in the production of wood preservatives, dyes, and also
as a pesticide. Human acute (short-term) exposure to 2,4-DNP in humans by means of oral
exposure are nausea or vomiting, sweating, headaches, dizziness, and weight reduction. Thus, the
removal of this compound is highly sought. A 2,4-DNP-degrading bacterium (isolate 1) was
isolated from a sample soil from Terengganu. This bacterium (isolate 1) was characterized as a
rod Gram positive, non-sporulated, and non-motile bacterium. The bacterium is oxidase negative
and had catalase positive activity and was able to grow aerobically on 2,4-dinitrophenol as the
sole carbon source. This bacterium showed maximal growth on 2,4-DNP at the temperature
optimum of 30 oC, pH 5.0 and was tolerant to 2,4-DNP concentration of up to 0.5 mM (0.092
g/L). This bacterium prefers to use urea as the nitrogen source in addition to yeast extract for
mineral source and vitamin precursors.

Matched MeSH terms: Vomiting
Fulltext 24-hour discharge post Laparoscopic Ovarian Cystectomy: a feasibility study

Wan Ahmad Hazim, Nur Hidayah Aeshah Ng, Salleha Khalid

Pertanika Journal of Science & Technology, 2018;26(2):719-728.
MyJurnal

Minimally invasive surgery results in faster recovery. The objective of this study is to identify criteria for the feasibility of 24-hour discharge post laparoscopic ovarian cystectomy. This is a prospective cross-sectional study that was carried out at the Obstetrics and Gynaecology Department in Putrajaya Hospital between 1 January and 31 December, 2016. The inclusion criteria were: age between 15 and 45, no comorbidities, no family history of malignancy, BMI of less than 30, mass size less than 18 weeks, single uninoculated simple cyst and no ascites. The exclusion criteria were post-menopause women, known medical illness, family history of malignancy, mass size more than 18 weeks, multiloculated or bilateral ovarian cyst, presence of solid area within the cyst and ascites. The sample size was calculated to be 14. A total of 16 participants were identified. Results showed that using the Visual Analogue Score (VAS), the mean pain score post operatively in the first six hours, 24 hours, 48 hours, two weeks and three months were 3.67, 2.57, 0.5, 0 and 0, respectively. Two of the subjects experienced post-operative nausea and vomiting, one had urinary tract infection and one had minor bleeding from the surgical site. All the participants were discharged within 24 hours post-operatively. There was no readmission. In conclusion, 24-hour discharge post laparoscopic cystectomy is safe and feasible. Factors determining the success must be adhered to closely to ensure a good and satisfactory outcome. This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Matched MeSH terms: Postoperative Nausea and Vomiting
Fulltext The socio-demographic and clinical factors associated with quality of life among patients with brain pathology in a tertiary referral hospital in Malaysia

Das, Priscilla, Naing, NyiNyi, Nadiah Wan-Arfah, Naing Noor Jan, K.O., Yee, Cheng Kueh, Rasalingam, Kantha

JUMMEC, 2019;22(1):50-57.
MyJurnal

Background: This paper investigates the quality of life of brain pathology patients in relation to their sociodemographic
profiles and clinical factors.

Methods: This is a cross-sectional study done at a tertiary referral hospital in Kuala Lumpur. A total of 100
patients were recruited in the study after excluding 22 patients who did not met the exclusion criteria. The
European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) self-administered
questionnaire was utilized in the study. The Global health status/QoL, Physical functioning, Role functioning,
Emotional functioning, Cognitive functioning, Social functioning, Fatigue, Nausea and vomiting, Pain, Dyspnoea,
Insomnia, Appetite loss, Constipation, Diarrhoea, and Financial difficulties were assessed in this study.

Results: The most severe impairment in functioning was with lowest score of cognitive functioning (mean
score=61) and the most severe symptom was fatigue (mean score=45). There were significant differences in
quality of life scores in different socio-demographic groupsand types of brain pathology patients. Patients aged
below 40 years old or less had better physical functioning, less symptoms of fatigue and insomnia compared
to patients who were more than 40 years old. Male patients faced more financial difficulties compared with
female patients. Patients who were married had increased insomnia compared to the single patients. Employed
patients had better physical functioning and less financial difficulties compared with patients who were
unemployed. Patients who earned >RM 2500.00 monthly had better physical functioning, less symptoms of pain and less financial difficulties than patients who earned ≤RM 2500.00. Patients with qualifications lower
than SPM tended to face more financial difficulties compared to patients with qualifications of SPM or higher.
Meningioma patients had better social functioning compared with others, whereas Carvenoma patients had
better physical functioning. Meningioma patients had more symptoms of insomnia compared with other
patients. All the findings were with p value less than 0.05.

Conclusion: The quality of life of patients with brain pathology is affected by socio-demographic factors and
clinical diagnoses. Efforts should be made to improve the overall quality of life of these patients.

Matched MeSH terms: Vomiting
Fulltext An unusual case of portal, splenic and mesenteric venous thrombosis presenting with acute abdomen

Yeoh, C.N., Cheah, S.K., Maaya, M., Nadiah, R., Raha, A.R., Wan, Mat W.R.

JUMMEC, 2019;22(1):8-12.
MyJurnal

Porto-spleno-mesenteric vein thrombosis is a rare, life-threatening condition of extrahepatic portal venous
system thrombosis. We report a rare case of a 49-year-old lady with late presentation of acute portal vein
thrombosis in a non-cirrhotic liver with an incidental finding of left adnexal teratoma. She presented with a
one-week history of severe abdominal pain associated with vomiting and diarrhea. She gave no history of prior
risk for venous thromboembolism or liver diseases. Physical examination revealed a tender mass extending from
suprapubic to left iliac fossa. Abdominal computed tomography scans showed a well-defined fat-containing left
adnexal mass, likely a benign teratoma, with no involvement of surrounding structures or calcification. There
was evidence of porto-splenic-mesenteric vein thrombosis with liver infarction, bowel and splenic ischemia.
Management of the extensive thrombosis causing multi-organ failure includes resuscitation, supportive care
and treatment of thrombosis. Treatment options include early anticoagulation and if feasible, thrombolysis.

Matched MeSH terms: Vomiting
Portal vein tumor thrombus from gastric cancer

Liang Ong SC, Batumaly SK, Jusoh SM

J Ultrason, 2018;18(75):365-368.
PMID: 30763024 DOI: 10.15557/JoU.2018.0054

A 53-year-old woman presented with left-sided abdominal pain, nausea and vomiting for the past 3 months with associated loss of appetite and weight. On physical examination, there was a large, ill-defined, firm mass at the epigastrium. Ultrasonography showed heterogeneously hypoechoic filling defect within the dilated main portal vein. The filling defect showed florid signals on Doppler mode and it appeared to be an extension of a larger periportal mass. Contrast enhanced abdominal computed tomography confirmed a large distal gastric mass infiltrating into the periportal structures, including the main portal vein and the splenic vein. Esophagogastroduodenoscopy performed 2 days later showed an irregular, exophytic mass extending from the antrum into the first part of duodenum. The mass was deemed inoperable. Histopathological examination showed gastric adenocarcinoma. She was started on anticoagulant, chemotherapy and pain management. Follow-up computed tomography 4 months later showed liver metastases and formation of collateral blood vessels.
A 53-year-old woman presented with left-sided abdominal pain, nausea and vomiting for the past 3 months with associated loss of appetite and weight. On physical examination, there was a large, ill-defined, firm mass at the epigastrium. Ultrasonography showed heterogeneously hypoechoic filling defect within the dilated main portal vein. The filling defect showed florid signals on Doppler mode and it appeared to be an extension of a larger periportal mass. Contrast enhanced abdominal computed tomography confirmed a large distal gastric mass infiltrating into the periportal structures, including the main portal vein and the splenic vein. Esophagogastroduodenoscopy performed 2 days later showed an irregular, exophytic mass extending from the antrum into the first part of duodenum. The mass was deemed inoperable. Histopathological examination showed gastric adenocarcinoma. She was started on anticoagulant, chemotherapy and pain management. Follow-up computed tomography 4 months later showed liver metastases and formation of collateral blood vessels.

Matched MeSH terms: Vomiting
Fulltext Correlations between subdural empyema and paraclinical as well as clinical parameters amongst urban malay paediatric patients

Nayan SA, Abdullah MS, Naing NN, Haspani MS, Md Ralib AR

Malays J Med Sci, 2008 Oct;15(4):19-27.
PMID: 22589634 MyJurnal

Paediatric subdural empyema is frequently seen in developing Asean countries secondary to rinosinusogenic origins. A cross-sectional analysis on the surgical treatment of intracranial subdural empyema in Hospital Kuala Lumpur (HKL), a major referral center, was done in 2004. A total number of 44 children who fulfilled the inclusion criteria were included into this study. The methods of first surgery, volume of empyema on contrasted CT brain, improvement of neurological status, re-surgery, mortality and morbidity, as well as the demographic data such as age, gender, sex, duration of illness, clinical presentation, probable origin of empyema, cultures and follow-up were studied. Chi-square test was performed to determine the association between surgical methods and the survival of the patients, neurological improvement, clearance of empyema on CT brain, re-surgery and long morbidity among the survivors. If the 20% or more of the cells were having expected frequency less than five, then Fisher's Exact test was applied. The level of significance was set at 0.05. SPSS version 12.0 was used for data entry and data analysis. There were 44 patients who were less than 18 years. Their mean age was 5.90 ± 6.01 years. There were 30 males (68.2%) and 14 females (31.8%) involved in the study. Malays were majority with 28 (63.6%) followed by Indian 8 (18.2%), Chinese 5 (11.4%) and others 3 (6.8%). The variables which were under interest were gender, race, headache, vomiting, seizures, sign of meningism, cranial nerve palsy, thickness site of abscess, first surgical treatment, improvement in neurological deficit, clearance of CT and whether re-surgery was necessary. All variables were found not to be associated with Henk W Mauser Score for PISDE grading. Comparison between this urban study and a rural setting study by the same corresponding author in the same period on subdural empyema was done. Common parameters were compared and it was found out that seizures were more prevalent in urban study where the patients are more than one year old (p=0.005). Mortality was much higher in urban study than the rural one (p=0.040). The larger proportion of urban group had volume of abscess less than or equal to 50 ml (p=< 0.001).

Matched MeSH terms: Vomiting
Fulltext Scedosporium apiospermum: A Rare Cause of Aggressive Orbital Apex Syndrome

Loh UL, Tai PY, Hussein A, A Qamarruddin F

Cureus, 2018 Dec 17;10(12):e3743.
PMID: 30800553 DOI: 10.7759/cureus.3743

Orbital apex syndrome (OAS) is a localized orbital cellulitis at the orbital apex that can cause vision loss from optic neuropathy and ophthalmoplegia involving multiple cranial nerves. Herein, we report a rare and rapidly progressive case of OAS secondary to fungal pansinusitis caused by Scedosporiumapiospermum in an immunocompromised patient following the extraction of abscessed teeth. A 48-year-old man with diabetes mellitus who had failed to adhere to his treatment presented with complaints of a right-sided headache and toothache for two weeks, with nausea and vomiting for two days prior to presentation. The patient was treated for septic shock secondary to the dental abscesses. Non-contrast brain computed tomography (CT) showed no significant intracranial abnormalities other than pansinusitis. Four days later, dental extraction was performed. The patient reported progressive painless blurring of the vision in his right eye following the dental extractions and was referred to the ophthalmology department. Subsequent examinations revealed decreased optic nerve function and ophthalmoplegia in his right eye and dental caries in the upper molars, with a mucopurulent discharge from the right sphenoid region. The clinical diagnosis was OAS. Pus near the orbital apex was drained surgically. Methicillin-resistant Staphylococcus aureus was isolated from the pus and a nasal swab. Tissue culture from the septal wall yielded S.apiospermum. The patient's condition deteriorated, despite intensive antibiotic and antifungal treatment and repeated surgical debridement. The disease progressed rapidly to his left eye. Sixty-seven days after the inital presentation, his visual acuity (VA) of both eyes was classified as no perception of light (NPL). The patient discharged himself from the hospital (at own risk discharge) and subsequently failed to attend a scheduled appointment in the ophthalmology clinic. If immunocompromised patients present with OAS, fungal infections should be ruled out. Prompt and aggressive treatment using a multidisciplinary approach is mandatory in cases of potentially life-threatening and vision-threatening fungal infections.

Matched MeSH terms: Vomiting
Fulltext Case review of sarcoidosis resembling Sjogren's syndrome

Ahmad Y, Shahril NS, Hussein H, Said MS

J Clin Med Res, 2010 Dec 11;2(6):284-8.
PMID: 22043264 DOI: 10.4021/jocmr482w

We would like to report a case of a 29-year-old male patient who presented with multiple lymphadenopathy and vague symptoms of low grade fever, cough, weight loss, rashes, vomiting, dry eyes and dry mouth. Physical examination revealed submandibular lymphadenopathy, vasculitic rashes over both lower limbs, and parotid gland enlargement. Blood investigations showed mild anemia with leukocytosis, predominantly eosinophilia and high erythrocyte sedimentation rate and C-reactive protein. Computed tomography of the neck, thorax and abdomen showed bilateral submandibular, submental adenopathy, mediastinal and para-aortic lymphadenopathy with generalized reticulonodular densities in both lower lobes. There were hepatomegaly and bilateral enlarged kidneys with renal cyst. Histopathological examination from the cervical lymph node later revealed non-caseating granuloma, consistent of sarcoidosis. Patient responded well to prednisolone 50 mg daily with subsequent reduction in the size of cervical lymphadenopathy and parotid swelling.

KEYWORDS: Lymphadenopathy; Granuloma; Sjogren; Sarcoidosis.

Matched MeSH terms: Vomiting
Fulltext Leptomeningeal Carcinomatosis With Optic Nerve Metastasis Secondary to Breast Cancer

Chew C, Wan Hitam WH, Ahmad Tajudin LS

Cureus, 2021 Mar 31;13(3):e14200.
PMID: 33936906 DOI: 10.7759/cureus.14200

Leptomeningeal carcinomatosis (LC) and optic nerve metastasis are uncommon occurrences in breast cancer. We report a rare case of LC with optic nerve infiltration secondary to breast cancer. A 45-year-old lady who was a known case of treated right breast carcinoma six years ago presented with a blurring of vision in both eyes, floaters, and diplopia for one month. She also had recurrent attacks of seizure-like episodes, headache, and vomiting. Examination revealed high blood pressure with tachycardia. Her right eye visual acuity was counting fingers at two feet and 6/36 in the left eye. She had right abducens nerve palsy. Fundoscopy showed bilateral optic disc swelling with pre-retinal, flame-shaped haemorrhages and macular oedema. CT scan of brain and orbit was normal. She was admitted for further investigations. While in the ward, her vision deteriorated further. Her visual acuity in both eyes was at the level of no perception to light. She also developed bilateral abducens nerve palsy and right facial nerve palsy. Subsequently, she started having bilateral hearing loss. There were few episodes of fluctuations in conscious awareness. MRI brain showed mild hydrocephalus. Both optic nerves were thickened and enhanced on T1-weighted and post-gadolinium. Lumbar puncture was performed. There was high opening pressure. Cerebrospinal fluid cytology showed the presence of malignant cells. Family members opted for palliative care in view of poor prognosis. Unfortunately, she succumbed after a month's stay in hospital. Diagnosis of LC and optic nerve infiltration presents a formidable challenge to clinicians especially in the early stages where neuroimaging appears normal and lumbar puncture has high false negatives. Multiple high-volume taps are advised if clinical suspicion of LC is high.

Matched MeSH terms: Vomiting

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