METHODS: Physician-diagnosed DGBI patients, recruited from 5 Eastern and 6 Western, completed the EAR4Q. We performed an exploratory and confirmatory factor analysis on questionnaire data to identify symptom groupings, describing distinct DGBI diagnostic entities.

RESULTS: In total, 1,074 DGBI patients (66.8% women, 42.6 ± 14.6 years) were recruited. We identified 10 distinct symptom groupings: (i) irritable bowel syndrome predominant diarrhea triggered by a meal and relieved by bowel movement or passing of flatus; (ii) constipation; (iii) upper GI symptoms with predominant regurgitation, nausea and vomiting; (iv) upper and lower GI symptoms relieved by bowel movement or flatus; (v) epigastric pain or burning related to bowel movement or passing flatus; (vi) lower GI symptoms triggered or worsened by bowel movement or passing flatus; (vii) meal-related pain and gas symptoms; (viii) globus and dysphagia; (ix) functional chest pain and heartburn; (x) constipation and belching relieved by bowel movement or passing flatus. Although some symptom groupings aligned with the Rome IV diagnostics, several clearly include multiple anatomical regions, surpassing the scope of the Rome regional subdivision approach.

PATIENT CONCERNS: A 61-year-old Asian female with underlying type 2 DM presented to our ED with body weakness, dyspnea, nausea, vomiting, and mild abdominal pain for the past 2 days. These symptoms were preceded by poor oral intake for 1 week due to severe toothache. Dapagliflozin was recently added to her antidiabetic drug regimen of metformin and glibenclamide 2 weeks ago.

DIAGNOSES: Arterial blood gases showed a picture of severe metabolic acidosis with an elevated anion gap, while ketones were elevated in blood and positive in urine. Blood glucose was mildly elevated at 180 mg/dL. Serum lactate levels were normal. Our patient was thus diagnosed with eDKA.

INTERVENTION: Our patient was promptly admitted to the intensive care unit and treated for eDKA through intravenous rehydration therapy with insulin infusion.

OUTCOMES: Serial blood gas analyses showed gradual resolution of the patient's ketoacidosis with normalized anion gap and clearance of serum ketones. She was discharged uneventfully on day 4, with permanent cessation of dapagliflozin administration.

MATERIALS AND METHODS: A descriptive study involved 58 Malays and 15 Chinese women newly diagnosed with breast cancer prior to treatment. Quality of life was measured using the Malay version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast-specific module (QLQ-BR23). Socio-demographic and clinical data were also collected. All the data were analyzed using SPSS version 20.0.

RESULTS: Most of the women were married with at least a secondary education and were in late stages of breast cancer. The Malay women had lower incomes (p=0.046) and more children (p=0.001) when compared to the Chinese women. Generally, both the Malay and Chinese women had good functioning quality-of-life scores [mean score range: 60.3-84.8 (Malays); 65.0-91.1 (Chinese)] and global quality of life [mean score 60.3, SD 22.2 (Malays); mean score 65.0, SD 26.6 (Chinese)]. The Malay women experienced more symptoms such as nausea and vomiting (p=0.002), dyspnoea (p=0.004), constipation (p<0.001) and breast-specific symptoms (p=0.041) when compared to the Chinese.