METHODS: A prospective study of 485 consecutive patients who underwent colonoscopy during a 22-month period was performed. All patients answered a detailed questionnaire. Indications for colonoscopy and the findings were recorded.
RESULTS: The mean age of the study population was 55.7 +/- 14.7 years. There were 221 (45.6%) males and 264 (54.4%) females. Sixty-five (13.4%) were Malays, 298 (61.4%) were Chinese and 112 (23.1%) were Indians. Multiple backward stepwise regression analysis revealed that independent predictors for colorectal cancer (odds ratio [95% CI]) were the presence of rectal bleeding (4.3 [4.0-8.0]) and iron deficiency anemia (4.0 [3.6-10.2]). In those aged 50 and over, male gender (4.5 [2.2-9.3]) and abdominal pain (3.1 [1.4-6.7]) were also significant positive predictors of cancer.
CONCLUSIONS: With the ever-increasing demand for gastrointestinal endoscopy, the appropriate utilization of colonoscopy is essential to afford prompt patient evaluation. Our study supports the need to prioritize the use of colonoscopy in patients with rectal bleeding and iron deficiency anemia. In the older patient where the background prevalence of colorectal cancer is higher, referral for colonoscopy is also justified.
METHODS: The patients selected had unequivocal evidence of H. pylori infection based on urease test, culture and histology on antral and corpus biopsies obtained at endoscopy. Patients received pantoprazole 40 mg twice a day, clarithromycin 500 mg twice a day and amoxycillin 1 g twice a day for 1 week and were assessed for successful eradication at least 4 weeks after completion of therapy by repeat gastroscopy and gastric biopsies. Eradication was defined as absence of bacteria in both antral and corpus biopsies tested by culture, histology and urease test.
RESULTS: One hundred and six patients were recruited for the study. The mean age was 48.0 years (range: 23-74 years). Four patients defaulted follow up and five patients were not compliant (taking less than 85%) with medications. Eradication rates on per-protocol analysis were: 88/97 (90.7%; 95% CI: 83.1-95.7); and on intention-to-treat analysis they were: 88/106 (83.0%; 95% CI: 75.9-90.2). Side-effects were in general mild and tolerable: 57 of 106 (53.7%) patients complained of a bitter taste; 15 (14.1%) complained of giddiness; 10 (9.4%) complained of increased abdominal pain; 11 (11.5%) complained of lethargy and 16 (15.1%) complained of loose motions. Pre-treatment metronidazole resistance was encountered in 57/74 strains (77.0%). Clarithromycin resistance was not encountered in any of the strains.
CONCLUSIONS: The pantoprazole 1-week triple therapy with amoxycillin and clarithromycin is effective in H. pylori eradication. The treatment was well tolerated by patients. Metronidazole resistance was reported in a high percentage of strains isolated from patients. Clarithromycin resistance was, however, not detected in any of the strains.
Methods: We conducted a comparative cross-sectional study between tuberculosis cases and tuberculosis contacts among pediatric patients using the Tuberculosis Information System as a source population. All notified cases that fulfilled the inclusion and exclusion criteria were included in the study. Descriptive statistics, simple and multiple logistic regressions were used for data analysis.
Results: Of 5412 tuberculosis cases, 456 (8.4%) were pediatric patients with a mean age of 15.9 years. The majority had the pulmonary form of tuberculosis (78.1%) followed by the extrapulmonary (14.9%) and pulmonary form with concomitant extrapulmonary (7.0%) forms. Of all pulmonary tuberculosis cases, 64.9% were sputum smear-positive, and 35.1% were sputum smear-negative. Among 322 pediatric patients with tuberculosis, the majority were Malay (90.7%), 8.4% were illiterate, and 79.5% resided in non-urban areas. Of all cases, 2.8% were HIV-positive, and 14.6% were cigarette smokers. Older age, Malay ethnicity, female gender, non-urban residence, good education level, and cigarette smoking were the significant associated factors for tuberculosis disease among pediatric patients with an adjusted odds ratio (aOR) of 1.41 (95% confidence interval (CI): 1.29-1.54; p < 0.001), 0.17 (95% CI: 0.07-0.44; p < 0.001), 1.88 (95% CI: 1.33-2.65; p < 0.001), 1.92 (95% CI: 1.33-2.79; p = 0.001), 0.20 (95% CI: 0.12-0.33; p < 0.001), and 3.35 (95% CI: 1.86-6.01; p < 0.001), respectively.
Conclusions: The study will assist practices of tuberculosis detection and control management in the local setting and may help other national tuberculosis programs to review their detection criteria with similar statistics.