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Biliary cystadenoma is a rare tumor of the biliary tree and a rare cause of obstructive jaundice. Most are intrahepatic, and pure extrahepatic biliary cystadenoma is less common. Cases are more common in women. Unless suspected, diagnosis of extrahepatic biliary cystadenoma is often delayed. Here, we report the case of a young woman with extrahepatic biliary cystadenoma who presented at Raja Isteri Pengiran Anak Saleha Hospital with obstructive jaundice initially thought to be due to a large biliary stone based on the endoscopic cholangiogram image. She was successfully managed with resection of the cystadenoma.

Introduction: The practice of high-fidelity simulation-based medical education has become a popular small-group teaching modality across all spheres of clinical medicine. High-fidelity simulation (HFS) is now being increasingly used in the context of undergraduate medical education, but its superiority over traditional teaching methods is still not established. The main objective of this study was to analyse the effectiveness of HFS-based teaching over video-assisted lecture (VAL)-based teaching in the enhancement of knowledge for the management of tension pneumothorax among undergraduate medical students. Methods: A cohort of 111 final-year undergraduate medical students were randomised for this study. The efficacy of HFS-based teaching (intervention group) and VAL-based teaching (control group), on the acquisition of knowledge, was assessed by single-best answer multiple choice questions (MCQ) tests in the first and eighth week of their surgery posting. Mean and standard deviation (SD) for the total score of MCQ assessments were used as outcome measures. ANCOVA was used to determine the difference in post-test MCQ marks between groups. The intragroup comparison of the pre-test and post-test MCQ scores was done by using paired t-test. The P-value was set at 0.05. Results: The mean of post-test MCQ scores were significantly higher than the mean of pre-test MCQ scores in both groups. The mean pre-test and post-test MCQ scores in the intervention group were slightly more than those of the control group but not statistically significant. Conclusion: There was a statistically significant enhancement of knowledge in both groups but the difference in knowledge enhancement between the groups was insignificant.

The effects of elemental substitutions at the Tl site of a Tl1−xXx(Ba, Sr)CaCu2O7 superconductor with X = Cr, Bi, Pb, Se, and Te were investigated. This study aimed to determine the elements that enhance and suppress the superconducting transition temperature of the Tl1−xXx(Ba, Sr)CaCu2O7 (Tl-1212) phase. The selected elements belong to the groups of transition metal, post-transition metal, non-metal, and metalloid. The relationship between the transition temperature and ionic radius of the elements was also discussed. The samples were prepared by the solid-state reaction method. The XRD patterns showed a single Tl-1212 phase was formed in the non- and Cr-substituted (x = 0.15) samples. The Cr-substituted samples (x = 0.4) showed a plate-like structure with smaller voids. The highest superconducting transition temperatures (Tc onset, Tcχ′, and Tp) were also achieved by the Cr-substituted samples for x = 0.4 compositions. However, the substitution of Te suppressed the superconductivity of the Tl-1212 phase. Jc inter (Tp) for all samples was calculated to be in the range of 12–17 A/cm2. This work shows that substitution elements with a smaller ionic radius tend to be more favorable in improving the superconducting properties of the Tl-1212 phase.

Immediate resuscitation is crucial for the survival of a patient with cardiac arrest. Research has suggested that self-led bystander cardiopulmonary resuscitation (CPR) is significantly associated with favourable neurological outcomes for patients. Furthermore, medical students play an important role in providing public CPR training to the community. This study aims to evaluate the effects of a CPR training programmes and a public training event on the knowledge, attitudes, and perceived competency towards CPR among medical students. The quasi-experimental study was conducted among the medical students in clinical years studying at a private medical institution in Malaysia. The intervention group received CPR training for two sessions and participated as trainers in a community-training event; the control group was excluded from these activities. A total of 106 students (intervention group, n = 51; control group, n = 55) participated in this study. The total knowledge score (5.24 ± 1.67 vs 3.75 ± 1.22, P < 0.001), attitude score (22.38 ± 3.67 vs 20.82 ± 2.33, P = 0.011), and perceived competencies to perform CPR and automated external defibrillator (AED) (7.22 ± 2.33 vs 4.93 ± 2.40, P < 0.001) were significantly higher among the participants in the intervention group compared to those in the control group after the intervention. Meanwhile, concerns regarding initiating CPR was significantly higher in the intervention group compared to the control group (12.44 ± 5.15 vs 9.55 ± 3.96, P = 0.002). The results suggested that CPR training is beneficial for students and should be organised regularly. In addition to providing physical skills training, such sessions should explain legal implications of initiating CPR and should encourage and assure students to do so in case of an emergency. [ABSTRACT FROM AUTHOR]

Laryngopharyngeal reflux (LPR) is common in clinical practice. Heterotopic gastric mucosal patch of the proximal esophagus (HGMP) is reported to cause LPR symptoms. This study assessed the prevalence of LPR symptoms and correlation with the size of HGMP. Four hundred and sixty-two patients undergoing endoscopy were carefully questioned regarding LPR symptoms experienced in the previous 12 weeks. The size of the HGMP was assessed and documented during endoscopy. Clinicopathological classifications were assigned (types I-V) accordingly. HGMP [median one patch (range 1-3), median size 15 mm [-] was detected in 26 (19 HGM type I and 7 HGM type II] patients giving a prevalence of 5.6%. Among the indications, there were significantly more LPR symptoms as referral indications among patients with HGMP. There were no significant differences in the endoscopic findings. On specific enquiries, significantly more HGMP patients had experienced any LPR symptoms (73.1 vs. 25.9%, p < 0.001) specifically chronic cough ( p = 0.002), throat discomfort/hoarseness ( p < 0.001), globus sensation ( p = 0.004), regurgitation ( p < 0.001). HGMP patients also had more heartburn ( p = 0.001). Larger HGMP (≥15 mm) was only associated with more chronic cough ( p = 0.022). In conclusion, patients with HGMP have significantly more LPR symptoms. However, most were mild and detected through specific enquiries. Interestingly, the size of HGMP did not significantly affect the prevalence of LPR symptoms. [ABSTRACT FROM AUTHOR]

Abstract  A solitary duodenal hamartomatous polyp is rare and it is considered to be either a variant of Peutz-Jeghers syndrome (PJS) or a separate entity. Patients do not have cutaneous manifestations and have only one hamartomatous polyp. The presentation is nonspecific and it resembles common conditions, such as a peptic ulcer disease. Most are incidentally diagnosed during endoscopy for other indications. Malignant transformation has been reported. This report describes the case of a 46-year-old man who presented with chronic intermittent abdominal pain. The initial endoscopy showed an abnormal twisting of the duodenum with a dilated duodenum. He was later diagnosed to have a solitary duodenal hamartomatous polyp with malignant transformation, which was treated by surgery. A review of the literature on the pertinent cases of this type of lesion is also presented. [ABSTRACT FROM AUTHOR]

Abstract: Longitudinal and shear ultrasonic velocity in Zn substituted GdBaSr(Cu3− x Zn x )O7− δ (, 0.01, 0.03, 0.06 and 0.1) superconductors have been measured using the pulsed-echo-overlap method with frequency 5–10MHz in the temperature range of 80–300K. An elastic anomaly characterized by a slope change was observed in the sample in the longitudinal mode at around 220K. This anomaly shifts towards lower temperature with increasing Zn content and vanishes when and 0.1. The characteristic Debye temperature and electron–phonon coupling constant were estimated using the standard BCS theory as well as the two-dimensional van Hove scenario. The variation in the elastic behaviours upon Zn doping may be due to the effect of changes in the spin correlation at the CuO2 planes. [Copyright &y& Elsevier]

Abstract Cardiovascular disease (CVD) is strongly associated with the gut microbiota and its metabolites, including trimethylamine-N-oxide (TMAO), formed from metaorganismal metabolism of ʟ-carnitine. Raw garlic juice, with allicin as its primary compound, exhibits considerable effects on the gut microbiota. This study validated the benefits of raw garlic juice against CVD risk via modulation of the gut microbiota and its metabolites. Allicin supplementation significantly decreased serum TMAO in ʟ-carnitine-fed C57BL/6 J mice, reduced aortic lesions, and altered the fecal microbiota in carnitine-induced, atherosclerosis-prone, apolipoprotein E-deficient (ApoE−/−) mice. In human subjects exhibiting high-TMAO production, raw garlic juice intake for a week reduced TMAO formation, improved gut microbial diversity, and increased the relative abundances of beneficial bacteria. In in vitro and ex vivo studies, raw garlic juice and allicin inhibited γ-butyrobetaine (γBB) and trimethylamine production by the gut microbiota. Thus, raw garlic juice and allicin can potentially prevent cardiovascular disease by decreasing TMAO production via gut microbiota modulation.

Biliary cystadenoma is a rare tumor of the biliary tree and a rare cause of obstructive jaundice. Most are intrahepatic, and pure extrahepatic biliary cystadenoma is less common. Cases are more common in women. Unless suspected, diagnosis of extrahepatic biliary cystadenoma is often delayed. Here, we report the case of a young woman with extrahepatic biliary cystadenoma who presented at Raja Isteri Pengiran Anak Saleha Hospital with obstructive jaundice initially thought to be due to a large biliary stone based on the endoscopic cholangiogram image. She was successfully managed with resection of the cystadenoma. [ABSTRACT FROM AUTHOR]