BACKGROUND Despite high risk of bacterial contamination, yet there are no studies that have evaluated the optimal hang time of blenderized and reconstituted powdered formulas at standard room temperature and high temperature. AIM To investigate the optimal hang time of both types of formulas at standard room temperature and high temperature. METHODS Ten specimens of blenderized formula and 10 specimens of reconstituted powdered formula were prepared using aseptic techniques. Five specimens of each formula were administered at 25 °C and 32 °C. Simulated administration was done in an incubator. The samples were collected at 0, 2, 4, 6 h and aerobic culture was performed. Food and drug administration criteria were used to determine the unacceptable levels of bacterial contamination. RESULTS Unacceptable contamination for blenderized formula began at 4 h at 25 °C and at 2 h at 32 °C. As for the reconstituted powdered formula, there was no bacterial growth in all specimens up to 6 h at both temperatures. CONCLUSION The optimal hang time to avoid significant bacterial contamination of the blenderized formula should be limited to 2 h at standard room temperature and be administered by bolus method at high temperature, while a reconstituted powdered formula may hang up to 6 h at both temperatures.

ObjectiveWe aimed to study the prevalence of achlorhydria (AC) in a large Asian population.DesignMedical records of patients who underwent oesophagogastroduodenoscopy (OGD) with Congo red staining method at the Vichaiyut Hospital from January 2010 to December 2019 were retrospectively reviewed.ResultsA total of 3597 patients was recruited; 223 were excluded due to concurrent use of proton pump inhibitors. Eighteen from 3374 patients (0.53%) had AC. Seven patients were presented with permanent AC (5F, 2M) (median age=69 years; range 58–92). Among 11 patients with temporary AC (5M, 6F: mean age 73.4 years; SD 13.2 years), all had gastrointestinal Helicobacter pylori bacterial infection and were over 45 years old. After successful treatment for H. pylori, AC was absent among patients with temporary AC. If counting only patients over 45 years of age, the prevalence of AC was 0.68% (18/2614). No adverse events arising from Congo red occurred.ConclusionAC is relatively rare. Permanent and temporary AC were found only when they were over 55 and 45 years old, respectively. Staining Congo red on gastric mucosa can be safely and routinely incorporated into the OGD procedure for early detection of AC. We recommended a low-cost screening test such as serum vitamin B levels for screening only in patients aged 50 and over.

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INTRODUCTION: Amoebic colitis and liver abscess caused by Entamoeba histolytica is one of the most important enteropathogen, leading to 40-73 per 100,000 deaths annually worldwide.1,2 Transmission generally occurs by fecal-oral route and during male homosexual activity.3 Colonic involvement was seen in 58% patients with amoebic liver abscess, but only 7% presents with diarrhea and bleeding.4 CASE DESCRIPTION/METHODS: A 25-year-old MSM patient with newly diagnosed HIV infection had persistent low grade fever and diarrhea 3-4 times/day for 1 month. He sometimes noticed a small amount of fresh blood in the stool and had mild epigastric discomfort for 1 week. He had worsening abdominal pain, radiating to back and passed 1000 mL fresh blood per rectum. Physical examination showed fever (38.9oC), pallor and markedly enlarged liver with tenderness. Lab showed hemoglobin 6.1 g/dl, white blood cell count 25350 cell/ul (N 89%, L 4%, M 7%), total/direct bilirubin 1.8/1.1 mg/dL, SGOT/SGPT 353/111 U/L, albumin/globulin 2.7/6.6 g/dL, ALP 436 U/L. Colonoscopy showed a 3-cm hemi-circumferential ulcer covered by blood clots and exudative materials with friable mucosa at rectum (Figure 1). Biopsy was done at the ulcer. Abdominal CT showed a 15-cm rim-enhancing cystic lesion with internal septation occupying right liver lobe. Capsule disruption at segment VIII/V anterior aspect of liver was noted (Figure 2). Percutaneous drainage was done and found markedly turbid gray pus 500 ml. Histopathologic findings revealed severe active proctitis with ulcer and few trophozoites ingested red blood cells on the surface, compatible with amoebic proctitis (Figure 3a). The pus aspirated from the abscess showed Charcot Leyden crystals (Figure 3b). Serum for E. histolytica antigen and PCR were both positive. The final diagnosis was amoebic liver abscess with proctitis. The patient was treated with metronidazole for 2 months, with a decreased size of abscess on follow-up CT. No recurrent bleeding occurred. DISCUSSION: Although synchronous colonic lesions in amoebic liver abscess are present in over 50% patient, diarrhea and bleeding are uncommon, without unclear reasons. Caecum is the most commonly affected site (70%). Left sided ulcers are seen in elderly and those presenting with diarrhea. Oral or intravenous metronidazole or tinidazole leads to rapid clinical improvement of invasive amoebic colitis and liver abscess. Large abscess (>7.7 cm) with abnormal liver tests were predictive of drainage intervention.