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Fulltext Contralateral pleural effusion during chemotherapy for tuberculous pleural effusion

Puri MM, Arora VK

Med J Malaysia, 2000 Sep;55(3):382-4.
PMID: 11200723

A 25 year old woman developed a right pleural effusion 6 weeks after commencement of short course chemotherapy for left sided tuberculous pleural effusion. Since the patient improved following continuation of the same treatment, it is presumed to be a case of paradoxical response to anti-tuberculosis treatment.
Fulltext Using a syringe needle to cut dentin and dislodge and remove a metallic obstruction from the root canal

Vivekananda Pai AR, Arora V

J Conserv Dent, 2018 4 21;21(2):230-232.
PMID: 29674831 DOI: 10.4103/JCD.JCD_316_16

A metallic obstruction in the canal orifice of a maxillary right canine could not be bypassed during endodontic treatment. Aids such as ultrasonics and retrieval kits were not available for the removal of the obstruction. Therefore, a novel approach using a disposable syringe needle was employed. A 22-gauge needle was inserted into the orifice and turned in an arc with a gentle apical pressure and alternate rocking motion around the obstruction. This procedure was repeated few times to cut dentin and successfully dislodge and remove the obstruction using the sharp beveled tip of the needle. This case report demonstrates that, in the absence of other aids, the use of a disposable syringe needle is a simple, economical, and yet an effective technique for conservative removal of dentin and to dislodge and remove an obstruction from the root canal. However, its effectiveness depends on case selection and straight-line accessibility to the obstruction.
Fulltext A case of tuberculosis of the thyroid gland

Puri MM, Dougall P, Arora VK

Med J Malaysia, 2002 Jun;57(2):237-9.
PMID: 24326661

We report a case of tuberculosis of the thyroid gland associated with mediastinal lymphadenitis in a 30 years-old male, who presented with dysphagia and a mid line anterior neck swelling. Fine needle aspiration was positive for acid fast bacilli. He made an uneventful recovery with antituberculous drugs. Although seldom observed, tuberculosis should be kept in mind in te differential diagnisis of nodular lesions of the thyroid.
Acinic cell carcinoma of the parotid gland: A diagnostic dilemma on cytology

Sharma A, Ahuja S, Diwaker P, Wadhwa N, Arora VK

Malays J Pathol, 2019 Aug;41(2):191-194.
PMID: 31427555

INTRODUCTION: Acinic cell carcinoma (ACC) represents 1-6% of parotid gland neoplasms.
CASE REPORT: We report cytomorphological features of two uncommon variants of acinic cell carcinoma. The first case was an eleven-year-old female with a nodular mass in parotid and the FNA smears demonstrated a lymphoepithelial lesion composed of epithelial tumour cells with features of acinar cells in a lymphoid background. The second case was a 62-year-old male with a large parotid mass. The FNA smears revealed presence of extracellular, acellular amyloid-like material with tumour cells arranged in follicles.
DISCUSSION: Awareness of cytomorphological features of these unusual variants of acinic cell carcinoma may help to avoid diagnostic pitfall.
Prevalence and factors associated with probable obstructive sleep apnea among patients with hypertension in two primary care clinics in Miri, Sarawak, Malaysia

Ching SM, Singh R, Azmi FSB, Chong KL, Ong CRS, Ayob NAB, et al.

Ir J Med Sci, 2024 Feb;193(1):375-382.
PMID: 37204559 DOI: 10.1007/s11845-023-03397-4

PURPOSE: Obstructive sleep apnea (OSA) has been increasingly recognized as an important factor contributing to medical morbidity and mortality. It was reported that more than half of the population with hypertension had OSA. Limited studies have been done on assessing OSA in hypertensive patients. This study aimed to determine the prevalence, socio-demographic characteristics, and factors associated with probable OSA in hypertensive patients in primary care clinics in Sarawak.
METHODS: A cross-sectional study was carried out using a systematic random sampling method in hypertensive patients who attended two government primary care clinics in Sarawak. The STOP-Bang questionnaire was used to screen for OSA, and social-demographic data was captured with a questionnaire. Multiple logistic regressions were used to examine the determinants of the OSA.
RESULTS: A total of 410 patients were enrolled in this study. The mean age of study population patients was 56.4 years, with more than half being female. The mean blood pressure was 136/82. The prevalence of probable OSA among patients with hypertension was 54.4%. According to multiple logistic regression analyses, smoking (odds ratio [OR] 14.37, 95% confidence interval [CI] 3.335-61.947), retirees (OR 3.20, 95% CI 1.675-6.113), and being Chinese (OR 2.21, 95% CI 1.262-3.863) had a significant positive association with probable OSA.
CONCLUSIONS: Because of the high prevalence of probable OSA among patients with hypertension, primary care physicians should be more vigilant in identifying hypertensive patients with OSA risk. Early detection and intervention would reduce disease complications and healthcare costs.
Asia-Pacific association for study of liver guidelines on management of ascites in liver disease

Singh V, De A, Mehtani R, Angeli P, Maiwall R, Satapathy S, et al.

Hepatol Int, 2023 Aug;17(4):792-826.
PMID: 37237088 DOI: 10.1007/s12072-023-10536-7
'First week' is the crucial period for deciding living donor liver transplantation in patients with acute-on-chronic liver failure

Choudhury A, Vijayaraghavan R, Maiwall R, Kumar M, Duan Z, Yu C, et al.

Hepatol Int, 2021 Oct 04.
PMID: 34608586 DOI: 10.1007/s12072-021-10206-6

BACKGROUND AND AIMS: Acute-on-chronic liver failure (ACLF) is a rapidly progressive illness with high short-term mortality. Timely liver transplant (LT) may improve survival. We evaluated various indices for assessment of the severity of liver failure and their application for eligibility and timing of living donor LT (LDLT).
METHODS: Altogether 1021 patients were analyzed for the severity and organ failure at admission to determine transplant eligibility and 28 day survival with or without transplant.
RESULTS: The ACLF cohort [mean age 44 ± 12.2 years, males 81%) was of sick patients; 55% willing for LT at admission, though 63% of them were ineligible due to sepsis or organ failure. On day 4, recovery in sepsis and/or organ failure led to an improvement in transplant eligibility from 37% at baseline to 63.7%. Delay in LT up to 7 days led to a higher incidence of multiorgan failure (p
APASL clinical practice guidelines on the management of acute kidney injury in acute-on-chronic liver failure

Maiwall R, Singh SP, Angeli P, Moreau R, Krag A, Singh V, et al.

Hepatol Int, 2024 Apr 05.
PMID: 38578541 DOI: 10.1007/s12072-024-10650-0

Acute-on-chronic liver failure (ACLF) is a syndrome that is characterized by the rapid development of organ failures predisposing these patients to a high risk of short-term early death. The main causes of organ failure in these patients are bacterial infections and systemic inflammation, both of which can be severe. For the majority of these patients, a prompt liver transplant is still the only effective course of treatment. Kidneys are one of the most frequent extrahepatic organs that are affected in patients with ACLF, since acute kidney injury (AKI) is reported in 22.8-34% of patients with ACLF. Approach and management of kidney injury could improve overall outcomes in these patients. Importantly, patients with ACLF more frequently have stage 3 AKI with a low rate of response to the current treatment modalities. The objective of the present position paper is to critically review and analyze the published data on AKI in ACLF, evolve a consensus, and provide recommendations for early diagnosis, pathophysiology, prevention, and management of AKI in patients with ACLF. In the absence of direct evidence, we propose expert opinions for guidance in managing AKI in this very challenging group of patients and focus on areas of future research. This consensus will be of major importance to all hepatologists, liver transplant surgeons, and intensivists across the globe.
Correction to: Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

Sarin SK, Choudhury A, Sharma MK, Maiwall R, Al Mahtab M, Rahman S, et al.

Hepatol Int, 2019 11;13(6):826-828.
PMID: 31595462 DOI: 10.1007/s12072-019-09980-1

The article Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update, written by [Shiv Sarin], was originally published electronically on the publisher's internet portal (currently SpringerLink) on June 06, 2019 without open access.
Fulltext Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

Sarin SK, Choudhury A, Sharma MK, Maiwall R, Al Mahtab M, Rahman S, et al.

Hepatol Int, 2019 Jul;13(4):353-390.
PMID: 31172417 DOI: 10.1007/s12072-019-09946-3

The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. With international groups volunteering to join, the "APASL ACLF Research Consortium (AARC)" was formed in 2012, which continued to collect prospective ACLF patient data. Based on the prospective data analysis of nearly 1400 patients, the AARC consensus was published in 2014. In the past nearly four-and-a-half years, the AARC database has been enriched to about 5200 cases by major hepatology centers across Asia. The data published during the interim period were carefully analyzed and areas of contention and new developments in the field of ACLF were prioritized in a systematic manner. The AARC database was also approached for answering some of the issues where published data were limited, such as liver failure grading, its impact on the 'Golden Therapeutic Window', extrahepatic organ dysfunction and failure, development of sepsis, distinctive features of acute decompensation from ACLF and pediatric ACLF and the issues were analyzed. These initiatives concluded in a two-day meeting in October 2018 at New Delhi with finalization of the new AARC consensus. Only those statements, which were based on evidence using the Grade System and were unanimously recommended, were accepted. Finalized statements were again circulated to all the experts and subsequently presented at the AARC investigators meeting at the AASLD in November 2018. The suggestions from the experts were used to revise and finalize the consensus. After detailed deliberations and data analysis, the original definition of ACLF was found to withstand the test of time and be able to identify a homogenous group of patients presenting with liver failure. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals and criteria for liver transplantation for ACLF patients were proposed. The final consensus statements along with the relevant background information and areas requiring future studies are presented here.