Biomedical subjects

C J Khor

Publications and source records attributed to C J Khor.

5 recordsLinked to original sources

PubMed2005

Empirical treatment for the management of patients presenting with uninvestigated reflux symptoms: a prospective study in an Asian primary care population.

BACKGROUND: Data on Asian patients who present with reflux symptoms to their primary care physicians are limited. AIM: To determine whether empirical therapy without endoscopy is appropriate for patients who present to their primary care physicians with uninvestigated reflux symptoms without alarm symptoms. METHOD: Forty-seven patients presenting with uninvestigated, dominant reflux symptoms but without alarm features to their primary care physicians underwent endoscopy within 2 weeks of referral. Their endoscopic findings were compared with those of 162 primary care patients presenting with uninvestigated dominant dyspepsia. All patients, except those with ulcers, were treated with esomeprazole 20 mg b.d. for 2 weeks. Their treatment response was assessed at 2 weeks using a symptom score. RESULTS: Among patients with dominant reflux symptoms, 14 (30%) had erosive oesophagitis. No other clinically significant endoscopic findings were detected among them. In contrast, erosive oesophagitis and peptic ulcer were found in 13 (8%, P < 0.001 vs. reflux group), and 12 (7%, P = 0.06 vs. reflux group), respectively, of patients with dominant dyspepsia. Thirty-seven of forty-five (82%) of those with dominant reflux symptoms and 109 of 139 (78%; P = N.S. vs. reflux group) of those with dominant dyspepsia reported > or = 50% resolution of symptoms after esomeprazole treatment. CONCLUSIONS: Empirical proton pump inhibitor without endoscopy is reasonable for uninvestigated patients who present to primary care physicians with dominant reflux symptoms.

Adult↗

PubMed2000

Metronidazole-resistant Helicobacter pylori in an urban Asian population.

BACKGROUND: Helicobacter pylori eradication is the mainstay in the treatment of H. pylori-associated peptic ulcer disease. Metronidazole is an important component in most eradication regimens. However, the presence of metronidazole-resistant H. pylori adversely affects the efficacy of such regimens. We aimed to study the prevalence of metronidazole resistance in our population, and the factors associated with its presence. METHODS AND RESULTS: From September 1993 to September 1996, 459 H. pylori isolates were collected and analysed. The overall resistance rate was 62.7%. The rate was significantly higher among women compared with men (P < 0.05). When the results were analysed according to each year, there was a significant increase in the resistance rate from 50.5% in the first year to 72.7% in the third year (P = 0.0039). CONCLUSIONS: There was a significant rise in the prevalence of metronidazole resistance over a 3-year period. The presence of metronidazole resistance adversely affects the eradication rates of nitroimidazole-based regimens. Hence, in a population with a high prevalence of metronidazole resistance, the use of non-nitroimidazole-based therapy may be more efficacious. This information on resistance rates is important for the empirical choice of antibiotic against H. pylori in a population.

Adolescent↗

PubMed2000

Recurrence of Helicobacter pylori infection and duodenal ulcer relapse, following successful eradication in an urban east Asian population.

We aimed to determine the rate of Helicobacter pylori (HP) recurrence and duodenal ulcer relapse in patients of a hospital in Singapore over a period of at least one year from the time of eradication. Ninety-six consecutive duodenal ulcer patients with biopsy-proven HP eradication and healed ulcer were seen at 3-month intervals, and follow-up endoscopy was performed when dyspepsia recurred, at the end of one year after eradication, or at the time of recall if the patient had been lost to follow-up. HP status was determined by antral and corpus biopsies and by antral cultures. Sixty-five had been given triple therapy, and 31 received dual therapy with omeprazole + amoxycillin or clarythromycin. Median time to follow-up endoscopy was 12 months. Six patients (6.25%) were positive for HP infection after eradication. Recurrence of HP infection was detected at 9 and 10 months after confirmation of HP eradication in two patients, and at between 13 and 20 months in the remaining four. Two of these had recurrent duodenal ulcer; all but one had erosive duodenitis. Two other patients had recurrent duodenal ulcer despite absence of HP reinfection; they admitted to taking low-dose aspirin. It was concluded that the recurrence of HP infection is low at the end of one year after successful eradication therapy in this urban East Asian population. Ulcer relapse occurred in 4.17% (4/96) of patients, and was associated with recurrent HP infection or NSAID exposure.

Adolescent↗

PubMed1995

Chronic discoid lupus erythematosus: an immunopathological and electron microscopic study.

We studied 100 cases of chronic cutaneous discoid lupus erythematosus (DLE) to evaluate the diagnostic sensitivity of immunoreactant deposition and its possible role in basement membrane thickening. Histopathology was diagnostic in 71% of cases. Sixty-two percent (41/66) of lesions with thickened and 50% (17/34) with normal basement membrane had immunoreactant deposition. Ultrastructural study of 6 cases (3 with and 3 without immunoreactant deposition) with thickened basement membrane all showed reduplication of the lamina densa. Thickening of the basement membrane appears to be contributed mainly by reduplication of the lamina densa rather than by immunoreactant deposition. The direct immunofluorescence (DIF) test of lesional skin was positive in 58% of patients and was independent of duration of lesion, age and sex. Light microscopy has greater diagnostic sensitivity in confirming DLE lesions than DIF. Direct salt split skin technique did not increase DIF sensitivity. Scalp lesions showed the highest frequency (83%) of immunoreactant deposition. As C1q was the commonest immunoreactant found in our study, we suggest that it should be routinely used when DIF is employed in the evaluation of DLE. DIF is especially helpful in confirming cicatricial alopecia due to DLE.

Adolescent↗

PubMed1994

Leukemia cutis.

Leukemia cutis is an uncommon manifestation of leukemia that is strongly associated with the presence of extramedullary disease at other sites. Patients usually present with leukemia cutis concomitantly with systemic leukemia or after leukemia has been diagnosed. Acute monocytic, myelomonocytic, and the T-cell leukemias show the highest incidence of leukemia cutis. The lesions show varied morphology and can be difficult to distinguish both clinically and histopathologically from nonspecific cutaneous lesions, which occur much more frequently. Immunohistochemistry is useful in making the distinction between them. The prognosis in leukemia cutis is generally poor; the best results have been achieved with a combination of systemic and local therapy.

Antigens, CD↗