Introduction: Tuberculosis (TB) of the elbow joint is uncommon. Prompt diagnosis and treatment are important to prevent joint destruction and preserve function. We present a case of TB synovitis of the elbow joint in a patient with active rheumatoid arthritis (RA). Case description: A 56-year-old woman with a known seropositive RA on metho-trexate and Leflunomide was seen in the outpatient rheumatology clinic as part of her monthly follow-up. She com-plained of persistent bilateral elbow pain and swelling, despite optimisation of her disease-modifying antirheumatic drugs (DMARD) and steroid therapy. The suspicion for another diagnosis for her elbow symptoms stems from the persistent pain and swelling amidst increased titration of methotrexate and prednisolone dosages. Ultrasound scan of her elbows revealed bilateral complex olecranon bursitis with active synovitis. The left elbow aspiration yielded cloudy yellowish synovial fluid and the sample was sent for fluid culture, acid-fast bacilli (AFB) stain, and GeneXpert. No AFB was seen but the GeneXpert test confirmed the presence of Mycobacterium Tuberculosis. Thus, a diagnosis of TB synovitis of the left elbow was made, and she was promptly started on anti-tubercular therapy (ATT) consisting of Rifampicin, Isoniazid, Ethambutol and Pyrazinamide with the aim to complete 9 months of ATT. Conclusion: The diagnosis of tuberculous synovitis is challenging. In the absence of constitutional or respiratory symptoms, joint TB is usually low on the initial differential diagnosis in patients presenting with joint pain and swelling. The diagnosis is made even more difficult in patients with concomitant rheumatoid arthritis. This case demonstrates the importance of a high index of suspicion for TB, particularly when evaluating patients in high TB prevalence area with an underlying immunosuppressive state.
Non-cirrhotic portal hypertension (NCPH) is clinically defined as the presence of portal hypertension in the background of non cirrhotic liver. It is diagnosed by the findings in ultrasound of the hepatobiliary system and also oesophagogastroduodenoscopy (OGDS) that consistent with that of a portal hypertension, but otherwise has a relatively normal liver function and echotexture. The treatment mainly focuses on primary and secondary prophylaxis of variceal bleeding both pharmacologically like non-selective beta-blockers and octreotide, and non-pharmacologically like endoscopic band ligation of varices and sclerotherapy. In advance cases, sometimes surgery such as Porto systemic shunt or splenectomy may be required especially in patients with uncontrolled variceal bleeding or with symptomatic hypersplenism. Here we report a case of a young man who presented with upper gastro-intestinal bleeding, which was initially thought from a bleeding ulcer but was found to be secondary to oesophageal and gastro-oesophageal varices. Apart from having mild ascites, he has no other features of portal hypertension. His liver biochemistry and echotexture were also normal. Unfortunately, the patient was lost to follow up while he was still in the early stage of investigating the condition. The purpose of this case report is to share an uncommon occurrence of NCPH in East Malaysia, where liver cirrhosis predominates the aetiology of portal hypertension. Also, to the best of our knowledge, there is a very limited reporting of a similar case in this region.
Introduction: Nutrition is an issue of great academic and public importance. However, there is evidence that parents do not have family breakfast, lunch or dinner with their children. This study aims to assess the prevalence of having regular family breakfast, lunch, dinner among primary school children age 7 to 12 years in Kota Kinabalu and its association with children’s weight status. Methods: The study is based on 485 children (mean age: 11.5+/-0.7 years, 54% girls) randomly selected in five primary schools in Kota Kinabalu who participated in a cross-sectional school- based survey in 2019. Data on family meals were self-reported by the parents by answering a validated question- naire. Children’s height and weight were measured to determine BMI status. Binary regression analyses assessed the associations of having regular family meals with children’s obesity status and to assess potential differences in having family meals according to gender and parental education. Results: The mean BMI male gender 24.3 ± 4.05 versus mean BMI female gender 17.9 ± 3.62 from 7 to 12 years old. The father mean BMI was 33.2 ± 8.24 versus 26.17 ±
9.63 mean BMI in mother from 32 to 52 years old. The prevalence of obesity within five (5) selected schools in Kota Kinabalu was only 13.2%. Regarding potential socio-demographic determinants, children of higher educated parents (STPM, DIPLOMA)[OR = 1.85 (95% CI 1.20–2.85)] were more likely to have breakfast together, while children of lower educated parents (SRP, SPM) [OR = 1.08 (95% CI 0.91–1.44)] were more likely to have dinner together. No significant associations of having family meals with gender observed. The prevalence of regular family meals was 94.6%, 74.17% and 93.8% for breakfast, lunch and dinner respectively. Conclusion: This study showed that having regular family breakfast, lunch and dinner was associated with children normal BMI between 18.50-24.99.