Objectives/Hypothesis:To study the association between sleep apnea and hypertension in a younger age group than previously studied, adding upper airway sizes at endoscopy as important compounding variables not often included in the past.Study Design:Case control.Methods:We analyzed data on sleep‐disordered breathing (based on polysomnography tests), body mass index (BMI), neck circumference, upper airway endoscopy sizes, and habitus and health history in 120 hypertensive and 120 nonhypertensive participants in a clinic‐based setting. Independent t test, χ2, multivariate analysis, and binary logistic regression models were used for case‐control comparison.Results:The mean age of the participants was 27 years; 67.5% were male. The incidence and severity of sleep apnea were significantly higher in the hypertensive than the control subjects. Persons with hypertension had an OR of 2.7 times of having comorbid sleep apnea than patients without hypertension (95% confidence interval [CI] 1.2‐6.1). Persons with sleep apnea (AHI [apnea‐hypopnea index] ≥5) had an OR of 2.76 (95% CI 1.57‐4.86), and persons with severe sleep apnea (AHI ≥30) had an OR 7.94 (95% CI 4.21‐15.33) for having hypertension than did persons without sleep apnea. Although adjustments for the compounding factors, particularly BMI, decreased the OR to a large degree, subjects with severe sleep apnea were still 72% more likely to have hypertension than subjects without sleep apnea.Conclusions:Sleep apnea is related to hypertension in young adults aged 18 to 40 years. The association was more pronounced with the increasing severity of sleep apnea. Screening for sleep apnea should be considered in young adults with hypertension.

DESCRIPTIONWe describe a case of chronic tongue ulceration with systemic symptoms in a patient with poorly controlled diabetes. A biopsy of a lesion from the posterior third of the tongue showed features typical of histoplasmosis (figure 1). A CT of the thorax and abdomen revealed a diffuse reticulonodular pattern bilaterally ( figure 2A). The intraabdominal organs were normal. A diagnosis of disseminated histoplasmosis was made. The patient was started on intravenous amphotericin B for 3 weeks followed by oral itraconazole 100 mg twice a day for 1 month. A repeat CT thorax 6 weeks after antifungal treatment revealed resolution of the lesions (figure 2B).Disseminated histoplasmosis refers to a process of severe fungus colonisation in the lungs and other organs and body sites 1 The first ever case of disseminated histoplasmosis in a patient with diabetes living in a non-endemic area was reported in 1977.2 Since the AIDS epidemic, disseminated histoplasmosis is more commonly seen. Chronic infection often presents with pancytopenia, hepatosplenomegaly,

Introduction: The existence of new entity called occult hepatitis C virus (HCV) has become a raising and escalating concern among healthcare professionals worldwide. It is defined by the presence of viral RNA in liver and/or peripheral blood mononuclear cells (PBMCs) within non HCV-infected patients. Previous study had shown the occult HCV is infectious and capable of transmitting the virus to another host. Till today, HCV infection remains common among hemodialysis patients despite having the best preventive plans. Because of this, there is a significant concern about the source of viral transmission. The aim of the study was to identify and characterize occult HCV infection in PBMC sample of hemodialysis patients. This was an observational and cross sectional study. Materials and method: PBMCs were isolated from the whole blood using Ficoll-gradient centrifugation technique. The PBMCs were then subjected for cell counting and stored in -70O C until further used. HCV RNA were extracted from these cells and viral RNA were subjected for molecular assays, immune cells analysis and cells culture. Results: PBMCs were isolated from eleven (11) study patients and five (5) anti-HCV positive (control) patients. By using automated flow cytometry, PBMCs of each sample were counted and the average number of cells obtained range from 2x104 to 5x106 cells/ ml. Viral RNAs were extracted and quantitatively measured by using NanoDrop Spectrophotometers. The viral RNAs concentration obtained were between 24.7 and 258.9 ng/ml. The RNAs would be subjected for purification (ethanol precipitation) and further assays. Conclusion: The final findings might contribute to the clinical management of dialysis patients.

Introduction: For patients with acute upper non-variceal gastrointestinal bleeding (AUNVB), various guidelines and meta-analysis have shown that combination endoscopic treatment is superior to a single treatment modality (injection or thermal coagulation) as an endoscopic haemostatic technique. This study aim to assess the adherence to ‘best practice’ standards (an emphasis on endoscopic treatment modalities) for patients with non-variceal upper gastrointestinal bleeding with high risk stigmata on endoscopic findings. Methods: Between January 2015 and March 2016, consecutive charts of patients hospitalized for acute upper gastrointestinal bleeding in Hospital Tengku Ampuan Afzan, Kuantan were reviewed. Data regarding initial presentation, endoscopic findings and management were collected. The inclusion criteria were patients with peptic ulcer disease and high risk stigmata on endoscopic findings. Results: Eighty one patients were included in the final analysis. There were 62 males and 19 females patients with mean age of 62.5 ± 1.5. Although the statistical analysis was not significant, more than half of the patients (60.5%) were given a single treatment modality to achieve haemostasis. Only 33.3% and 6.2% patients received a combination of two and three treatment modalities respectively. Conclusions: There was marked variability between the process of care and ‘best practice’ in AUNVB. Certain patient and situational characteristics may influence guideline adherence. Further studies are needed to delineate the underlying causes.

Introduction: Hepatitis C virus (HCV) has been classified into seven genotypes with more than 80 subtypes isolated worldwide. HCV genotypes are an important parameter in determining the right antiviral dosage, duration and monitoring the response of that treatment. The main aim of this study was to determine the distribution of HCV genotypes, their association with demographic variables and to investigate the presence of uncommon mixed-genotype infection case. Methods: This cross sectional study was performed in Hospital Tengku Ampuan Afzan, Kuantan, Pahang from January to July 2014. The sera samples from 40 HCV seropositive patients were analyzed using reversetranscription PCR (RT-PCR) and direct DNA sequencing assays. Results: More than half of study patients were from male patients (32/40; 80%), below the age of 45 (27/40; 67.5%) and Malays (34/40; 77.5%). Thirty one out 40 (77.5%) samples were successfully sequenced for genotyping with genotype 3 (24/31; 77.4%) predominate the study, followed by genotype 1 (6/31; 19.3%). There is no significant association established between the demographic factors and HCV genotypes. Majority of the HCV RNA positive samples were identified as mono genotype HCV infection. There was one isolate with mixed-genotype infection. Conclusions: The findings of the study showed that genotype 3 and 1 are still the commonest genotypes found among the study population. No association can be established from HCV genotypes and basic demographic factors. The finding of mixed HCV genotype infection from this study requires further investigation to evaluate the clinical role of this type of infection in treatment outcome.