Primary biliary cholangitis(PBC)is an autoimmune disease that causes progressive destruction of the intrahepatic bile ducts.Although the pathogenesis of PBC is not completely understood,it is charac-terized by cholestatic inflammation resulting in a spectrum of cholangitis,varying degrees of fibrosis,and,potentially,cirrhosis.PBC affects all races;however,there have been few clinical studies of the disease in Asian countries,particularly in Southeast Asia,suggesting that PBC may be underreported in the Asian population.Here,we review the epidemiology,natural history,predictive and diagnostic features,and current and emerging treatments for PBC.Our goal is also to highlight current studies from Asian countries to provide a better understanding of PBC in this patient population.

Abdomen ; physiology ; Humans ; Manikins ; Physical Examination ; methods ; Singapore ; Students, Medical ; Teaching ; methods

A 49-year-old Chinese woman was referred to our hospital for management of multiple lung nodules, which were incidentally detected on routine chest radiography. Chest computed tomography (CT) confirmed the presence of multiple pulmonary nodules and lung cysts. The lung cysts were located apart from the pulmonary nodules. CT-guided biopsy of the pulmonary nodule specimens confirmed the diagnosis of nodular pulmonary amyloidosis. While cavitation of existing pulmonary amyloid nodules is a well-recognised feature of nodular pulmonary amyloidosis, widespread lung cysts located apart from pulmonary nodules is rare.
Amyloidosis ; diagnosis ; pathology ; Biopsy ; Cysts ; diagnosis ; Female ; Humans ; Immunohistochemistry ; Lung ; pathology ; Middle Aged ; Multiple Pulmonary Nodules ; diagnosis ; pathology ; Radiography, Thoracic ; Tomography, X-Ray Computed

INTRODUCTION: Despite adhering to criteria for extubation, up to 20% of intensive care patients require re-intubation, even with use of post-extubation high-flow nasal cannula (HFNC). This study aims to identify independent predictors and outcomes of extubation failure in patients who failed post-extubation HFNC. METHODS: We conducted a multicentre observational study involving 9 adult intensive care units (ICUs) across 5 public hospitals in Singapore. We included patients extubated to HFNC following spontaneous breathing trials. We compared patients who were successfully weaned off HFNC with those who failed HFNC (defined as re-intubation ≤7 days following extubation). Generalised additive logistic regression analysis was used to identify independent risk factors for failed HFNC. RESULTS: Among 244 patients (mean age: 63.92±15.51 years, 65.2% male, median APACHE II score 23.55±7.35), 41 (16.8%) failed HFNC; hypoxia, hypercapnia and excessive secretions were primary reasons. Stroke was an independent predictor of HFNC failure (odds ratio 2.48, 95% confidence interval 1.83-3.37). Failed HFNC, as compared to successful HFNC, was associated with increased median ICU length of stay (14 versus 7 days, CONCLUSION Post-extubation HFNC failure, especially in patients with stroke as a comorbidity, remains a clinical challenge and predicts poorer clinical outcomes. Our observational study highlights the need for future prospective trials to better identify patients at high risk of post-extubation HFNC failure.
Adult ; Airway Extubation ; Cannula ; Critical Care ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Respiratory Insufficiency/therapy* ; Singapore/epidemiology*