The Use of M2-Pyruvate Kinase as a Stool Biomarker for Detection of Colorectal Cancer in Tertiary Teaching Hospital: A Comparative Study

Shahidah Che Alhadi,Wan Zainira Wan Zain,Zalina Zahari,Mohd Nizam Md Hashim,Syed Hassan Syed Abd. Aziz,Zaidi Zakaria,Michael Pak-Kai Wong,Andee Dzulkarnaen Zakaria 대한대장항문학회 2020 Annals of Coloproctolgy Vol.36 No.6

Purpose: Guaiac fecal occult blood test (gFOBT) has been the standard for colorectal screening but it has low sensitivity and specificity. This study evaluated the use of fecal tumor M2-pyruvate kinase (M2-PK) for detection of colorectal cancer and to compare with the current surveillance tool; gFOBT in symptomatic adult subjects underwent colonoscopy.Methods: Stool samples were collected prospectively from symptomatic adults who had elective colonoscopy from September 2014 to January 2016 and were analyzed with the ScheBo M2-PK Quick test and laboratory detection of fecal hemoglobin.Results: The results were correlated to the colonoscopy findings and/or histopathology report. Eighty-five subjects (age of 56.8 ± 15.3 years [mean ± standard deviation]) were recruited with a total of 17 colorectal cancer (20.0%) and 10 colorectal adenoma patients (11.8%). The sensitivity of M2-PK test in colorectal cancer detection was higher than gFOBT (100% vs. 64.7%). M2-PK test had a lower specificity when compared to gFOBT (72.5% vs. 88.2%) in colorectal cancer detection. The positive and negative predictive values were 47.2% and 100% for M2-PK test and 57.9% and 90.9% for gFOBT.Conclusion: Fecal M2-PK Quick test has a high sensitivity for detection of colorectal cancer when compared to gFOBT, making it the potential choice for colorectal tumor screening biomarker in the future.

Risk factors associated with low anterior resection syndrome: a cross-sectional study

Lim See Liang,Wan Zain Wan Zainira,Zahari Zalina,Zakaria Andee Dzulkarnaen,Hashim Mohd Nizam Md,Wong Michael Pak-Kai,Zakaria Zaidi,Ramely Rosnelifaizur,Sidek Ahmad Shanwani Mohamed 대한대장항문학회 2023 Annals of Coloproctolgy Vol.39 No.5

Purpose: Oncological outcomes following rectal cancer surgery have improved significantly over recent decades with lower recurrences and longer overall survival. However, many of the patients experienced low anterior resection syndrome (LARS). This study identified the prevalence and risk factors associated with the development of LARS. Methods: This cross-sectional study involved patients who were diagnosed with rectal cancer and had undergone sphincter-preserving low anterior resection from January 2011 to December 2020. Upon clinic follow-up, patients were asked to complete an interviewed based questionnaire (LARS score) designed to assess bowel dysfunction after rectal cancer surgery. Results: Out of 76 patients, 25 patients (32.9%) had major LARS, 10 patients (13.2%) had minor LARS, and 41 patients (53.9%) had no LARS. The height of tumor from anal verge showed an association with the development of major LARS (P=0.039). Those patients with less than 8 cm tumor from anal verge had an increased risk of LARS by 3 times compared to those with 8 cm and above (adjusted odds ratio, 3.11; 95% confidence interval, 1.06–9.13). Conclusion: Results from our study show that low tumor height was a significant risk factor that has a negative impact on bowel function after surgery. The high prevalence of LARS emphasizes the need for study regarding risk factors and the importance of understanding the pathophysiology of LARS, in order for us to improve patient bowel function and quality of life after rectal cancer surgery.

Mammary Paget’s Disease of the Nipple: Relatively Common but Still Unknown to Many

Poh Siang Ooi,Nani Draman,Siti Suhaila Mohd Yusoff,Wan Zainira Wan Zain,Dharmendra Ganasagaran,Hui Heng Chua 대한가정의학회 2019 Korean Journal of Family Medicine Vol.40 No.4

Mammary Paget’s disease is clinically defined as skin inflammation of the nipple area and is an adenocarcinoma of the epidermis of the nipple. The pathogenesis of mammary Paget’s disease is relatively unknown; nonetheless, there are two popular theories that support the underlying carcinoma and de novo carcinogenesis. For the attend-ing medical practitioner, mammary Paget’s disease poses a diagnostic and therapeutic dilemma, especially in the absence of a clinically palpable breast mass. We report a rare case of a 48-year-old Malay woman who presented at Hospital Universiti Sains Malaysia, Kelantan, Malaysia with the symptom of skin erosion on the left nipple and un-responsiveness to multiple topical treatments. A full evaluation and assessment of the patient were conducted, and mammary Paget’s disease was diagnosed.

Conversion rate and risk factors of conversion to open in laparoscopic appendicectomy

Pushpanathan Nelson Rao,Hashim Mohd Nizam Md,Zahari Zalina,Aziz Syed Hassan Syed Abd.,Zain Wan Zainira Wan,Ramely Rosnelifaizur,Wong Michael Pak-Kai,Mohamad Ikhwan Sani,Mokhter Wan Mokhzani Wan,Yahya 대한대장항문학회 2022 Annals of Coloproctolgy Vol.38 No.6

Purpose: Laparoscopic appendicectomy (LA) has several advantages over conventional open appendicectomy (OA). However, about 5% to 10% of LA patients still need to be converted to open surgery. Identifying risk factors that contribute to conversion to OA allows for early identification of patients who may benefit from primary OA. This study aimed to determine the conversion rate of LA to OA and to identify its associated risk factors among patients with acute or perforated appendicitis. Methods: A retrospective review of medical records was performed among patients with acute or perforated appendicitis who underwent LA between December 2015 and January 2017. With the use of multivariable logistic regression analyses, the predictors of conversion from laparoscopic to OA were investigated. Results: Out of 120 patients, 33 cases were converted to OA which gives a conversion rate of 27.5%. Among 33 patients who were converted to OA, 27 patients (81.8%) had perforated appendix, while in the LA group, perforated appendix cases consisted of 34.5% (P<0.001). Histopathology of the appendix was the predictor of conversion from LA to OA (adjusted odds ratio, 8.82; 95% confidence interval, 3.13–24.91; P<0.001). Conclusion: The result from our study shows that the overall conversion rate for the study period was high. Patients with perforated appendicitis had a higher risk of conversion to OA. Therefore, preoperative diagnosis of perforated appendicitis may be paramount in predicting conversion to OA.

Predictors of early postoperative hypocalcemia after total parathyroidectomy in renal hyperparathyroidism

Poh Guan Tan,Imi Sairi Ab. Hadi,Zalina Zahari,Maya Mazuwin Yahya,Wan Zainira Wan Zain,Michael Pak-Kai Wong,Rosnelifaizur Ramely,Mohd Nizam Md Hashim,Syed Hassan Syed Abd. Aziz,Zaidi Zakaria,Andee Dzul 대한외과학회 2020 Annals of Surgical Treatment and Research(ASRT) Vol.98 No.1

Purpose: Patients with secondary hyperparathyroidism are at high risk for developing postoperative hypocalcemia. However, there are limited data regarding predictors of postoperative hypocalcemia in renal failure patient with secondary hyperparathyroidism. This study aimed to determine the clinical presentations of renal hyperparathyroidism and the predictors of early postoperative hypocalcemia after total parathyroidectomy. Methods: Data of patients with renal hyperparathyroidism who underwent total parathyroidectomy between January 2007 to December 2014 were reviewed retrospectively. Patients were divided into 2 cohort groups according to their serum calcium levels within 24 hours of parathyroidectomy: the hypocalcemia group (calcium levels of 2 mmol/L or less), and the normocalcemia group (calcium levels more than 2 mmol/L). With the use of multivariable logistic regression analyses, the predictors of early postoperative hypocalcemia after total parathyroidectomy in patients with renal hyperparathyroidism were investigated. Results: Among 68 patients, 56 patients (82.4%) were symptomatic preoperatively. Fifty patients (73.5%) presented with bone pain and 14 patients (20.6%) had muscle weakness. Early postoperative hypocalcemia occurred in 25 patients (36.8%). Preoperative alkaline phosphatase level was the predictor of early postoperative hypocalcemia (adjusted odds ratio, 1.004; 95% confidence interval, 1.001–1.006; P = 0.002). Conclusion: Results from our study show that most of the patients with renal hyperparathyroidism were symptomatic preoperatively and the most common clinical presentations were bone pain and muscle weakness. The significant predictor of early postoperative hypocalcemia after total parathyroidectomy was the preoperative alkaline phosphatase levels.