1.Intrapancreatic accessory spleen: An eluding diagnosis
Teoh Keat How ; Balraj Singh ; Navarasi S Raja Gopal
The Medical Journal of Malaysia 2017;72(1):68-70
Intrapancreatic accessory spleen (IPAS) is a benign anomaly
of splenic embryology and a rare cause of pancreatic
pseudotumour. Here, we report a case of a 70-year-old Malay
lady whose IPAS was discovered incidentally during her
surveillance computed tomography for her underlying left
lower lung fibrosis. Radiologically, the lesion mimicked a
neuroendocrine pancreatic tumour and was only diagnosed
pathologically as IPAS after surgery. In conclusion,
recognising IPAS as a differential for enhancing pancreatic
mass allows us to exhaust all non-invasive diagnostic
means to diagnose this benign lesion. It will allow the patient
to avoid unnecessary surgery and its accompanying
complications.
Spleen
;
Splenectomy
;
Pancrelipase
2.Achalasia Is Associated With eNOS4a4a, iNOS22GA, and nNOS29TT Genotypes: A Case-control Study.
Rajan SINGH ; Uday C GHOSHAL ; Asha MISRA ; Balraj MITTAL
Journal of Neurogastroenterology and Motility 2015;21(3):380-389
BACKGROUND/AIMS: Achalasia is known to result from degeneration of inhibitory neurons, which are mostly nitrinergic. Characteristic features of achalasia include incomplete lower esophageal sphincter (LES) relaxation and esophageal aperistalsis. Nitric oxide (NO), produced by NO synthase (NOS), plays an important role in peristalsis and LES relaxation. Therefore, we evaluated genetic polymorphisms of NOS gene isoforms (endothelial NOS [eNOS], inducible NOS [iNOS], and neuronal NOS [nNOS]) in patients with achalasia and healthy subjects (HS). METHODS: Consecutive patients with achalasia (diagnosed using esophageal manometry) and HS were genotyped for 27-base pair (bp) eNOS variable number of tandem repeats (VNTR), iNOS22G/A (rs1060826), nNOS C/T (rs2682826) polymorphisms by polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism (RFLP), respectively. RESULTS: Among 183 patients (118 [64.5%] male, age 39.5 +/- 13.0 years) with achalasia and 366 HS (254 [69.4%] male, age 40.8 +/- 11.0 years), eNOS4a4a genotype of 27-bp VNTR was more common among achalasia than HS (20 [10.9%] vs 13 [3.6%]; P < 0.001; OR, 3.72; 95% CI, 1.8-7.7). Patients with achalasia had iNOS22GA genotypes more often than HS (95 [51.9%] vs 93 [25.4%]; P < 0.001; OR, 3.0; 95% CI, 2.1-4.4). Frequency of genotypes GA + AA was higher in patients than HS (97 [53%] vs 107 [29.2%]; P < 0.001; OR, 2.7; 95% CI, 1.8-3.9). Also, nNOS29TT variant genotype in rs2682826 was more common among patients compared to HS (14 [7.7%] vs 6 [1.6%]; P < 0.001; OR, 5.91; 95% CI, 2.2-15.8). CONCLUSIONS: Achalasia is associated with eNOS4a4a, iNOS22GA, and nNOS29TT genotypes. This may suggest that polymorphisms of eNOS, iNOS, and nNOS genes are risk factors for achalasia.
Case-Control Studies*
;
Esophageal Achalasia*
;
Esophageal Motility Disorders
;
Esophageal Sphincter, Lower
;
Genotype*
;
Humans
;
Male
;
Minisatellite Repeats
;
Neurons
;
Nitric Oxide
;
Nitric Oxide Synthase
;
Peristalsis
;
Polymerase Chain Reaction
;
Polymorphism, Genetic
;
Protein Isoforms
;
Relaxation
;
Risk Factors
3.Acute Intestinal Ischemia in a Patient with COVID-19 Infection
Balraj SINGH ; Ashesha MECHINENI ; Parminder KAUR ; Nora AJDIR ; Michael MAROULES ; Fayez SHAMOON ; Mahesh BIKKINA
The Korean Journal of Gastroenterology 2020;76(3):164-166
The World Health Organization has declared novel coronavirus disease 2019 (COVID-19) a global public health emergency. Although respiratory symptoms predominate in COVID-19, thrombosis can occur in patients with COVID-19. This paper reports a case of an 82-year-old female with a prior medical history of hypertension, diabetes presenting with fever and cough, and was diagnosed with COVID-19. The patient subsequently developed progressively worsening of abdominal distention, tenderness, and underwent emergent laparotomy. She was found to have a gangrenous colon. This case adds to the limited literature regarding the extrapulmonary complications of COVID-19.
4.Epilepsy in Southeast Asia, how much have we closed the management gap in past two decades?
Kheng-Seang Lim ; Zhi-Jien Chia ; Moe-Zaw Myint ; Kazi Jannat Ara ; Yong-Chuan Chee ; Woon-Theng Heng ; Thanmidraaj-Kaur Balraj Singh ; Janice-Ying-Qian Ong ; Slocahnah SreeKumar ; Minh-An Thuy Lee ; Si-Lei Fong ; Chong-Tin Tan
Neurology Asia 2020;25(4):425-438
The last review on epilepsy in Southeast Asian (SEA) countries was reported in 1997. This review
aimed to update the understanding of epilepsy management in this region over the past 23 years. There
has been significant increase in the epidemiological studies which reported a prevalence of 4.3-7.7 per
1,000 populations in this region. Reversible aetiologies of epilepsy such as head injury, birth trauma,
cerebrovascular disease, and intracranial infections (neurocysticercosis or meningoencephalitis) are
still prevalent, with a surge in autoimmune encephalitis. There was a surge in genetic studies which
suggest ethnic variation. Treatment gap is still high especially in the rural and less developed areas,
and the availability and affordability of newer anti-epileptic drugs (AEDs) is still a major challenge
in SEA. Alternative medicine is a common practice but varies among different ethnic groups. AEDs
hypersensitivity especially on the association between HLA-B*1502 and carbamazepine-related severe
cutaneous reaction had been extensively studied and proven in nearly all SEA countries. However,
HLA-B*1502 screening is not widely available in SEA and the cost-effectiveness of the screening is
questionable. Stigma and its psychosocial consequences are still a major concern despite enormous
efforts to study the public attitudes towards epilepsy and change of epilepsy naming in a few countries.
The number and complexity of epilepsy surgery are progressing, but it is still under-utilized in many
SEA countries, related to cost, cultural perception and lack of facilities. More resources should also
be channelled in training adequate number of epileptologists who can spearhead epilepsy care around
the region, as well as public education and research in epilepsy. In conclusion, there is an increase in
epilepsy research in this region, gradual increase in trained neurologists and facilities, and efforts to
reduce the knowledge and treatment gap, but the epilepsy management gap is still a battle to fight.