Browse publications by year: 2013

  1. Mohd Razali K
    Med J Malaysia, 2013 Apr;68(2):173-4.
    PMID: 23629570 MyJurnal
    This case report is about a rare disease with unusual presentation. Failure to recognise atypical presentation may lead to error in managing the patient and cause disastrous complications. Here we highlight a case of Terrien Marginal Degeneration in both eyes with atypical presentation; namely pseudopterygium. A 22 year old man was referred to our centre for iatrogenic right eye corneal perforation after having an atypical pterygium removed at another hospital. On arrival, his vision was 1/60 in both eyes with bilateral cornea Terrien Marginal Degeneration. His right eye anterior chamber was deep with a conjunctival flap covering the perforation site which was located from the 2.30 - 3.30 clock position nasally with no aqueous leak. However after a day his right eye anterior chamber became flat and there was fast aqueous leak from the perforation site. An emergency C shaped peripheral corneal lamellar keratoplasty was performed to seal the perforation. Post operatively his right eye improved to 6/24.
    MeSH terms: Cornea/surgery; Corneal Diseases/surgery; Humans; Iatrogenic Disease*; Visual Acuity; Corneal Transplantation; Corneal Perforation*
  2. Sachithanandan A, Nor Y
    Med J Malaysia, 2013 Apr;68(2):175-6.
    PMID: 23629571 MyJurnal
    Synchronous primary non-small cell lung cancers (NSCLC) are rare and may be discovered unexpectedly following lung resection. Discrimination from intrapulmonary metastases is important to guide treatment and prognosis but is difficult solely on clinical or radiological findings. Histopathological evaluation with immunohistochemistry (IHC) markers can prove decisive and should feature in the diagnostic algorithm of such patients. We report a rare case of two synchronous primary NSCLCs diagnosed post operatively following pathological examination of the resected lobe, highlighting the value of IHC and discuss the management of such patients.
    MeSH terms: Carcinoma, Non-Small-Cell Lung*; Diagnosis, Differential; Humans; Immunohistochemistry; Prognosis
  3. Dharmalingam TK, Nor Azian AZ, Thiruselvi S, Abdul Aziz J
    Med J Malaysia, 2013 Apr;68(2):177-8.
    PMID: 23629572
    Left bundle branch block (LBBB) during anaesthesia is uncommon. During general anaesthesia, LBBB may be related to hypertension or tachycardia and its acute onset makes the diagnosis of acute myocardial ischemia or infarction difficult. We would like to present a case report of a healthy patient who developed LBBB intra operatively. Acute LBBB should lead to suspicion of acute coronary syndrome until proven otherwise. Inability to exclude an acute cardiac event resulted in postponement of surgery twice after general anaesthesia was administered. Cardiological investigation of our patient showed physiological left ventricular hypertrophy (LVH), "athlete's heart" which was the most likely cause of the LBBB under anaesthesia.
    MeSH terms: Anesthesia, General; Bundle-Branch Block*; Electrocardiography; Humans; Hypertension; Myocardial Infarction; Athletes*
  4. Wong KW
    Med J Malaysia, 2013 Apr;68(2):179-80.
    PMID: 23629573 MyJurnal
    We report a case of melioidosis presenting as peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD). A 47-year-old man, a lorry driver, with end-stage renal disease due to diabetes mellitus on CAPD presented in PD-related peritonitis. He was started on intraperitoneal cloxacillin and ceftazidime, and changed to intraperitoneal vancomycin and meropenam after day 5 due to nonresponse. Burkholderia pseudomallei was identified from the dialysate culture. He was treated with intraperitoneal meropenam for two weeks, and IV ceftazidime for 4 weeks. He responded, and the Tenckhoff catheter was not removed. He was discharged well and continued on oral sulfamethoxazole/trimethoprim for six months. This patient had done his PD exchanges in a lorry.
    MeSH terms: Humans; Kidney Failure, Chronic/therapy; Melioidosis*; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis*
  5. Yaroko AA, Shahrjerdi B, Md Daud MK
    Med J Malaysia, 2013 Apr;68(2):181-2.
    PMID: 23629574 MyJurnal
    Sensorineural hearing loss following trauma is a common finding in daily clinical practice and usually associated with a poor prognosis. Our case illustrates a patient who was involved in motor vehicle accident sustaining bilateral severe to profound sensorineural hearing loss but subsequently recovered fully after two years. Unless there is clear trauma to the cochlea or auditory nerve, a substantial duration of follow up is needed in the treatment of such cases.
    MeSH terms: Accidents; Cochlea; Hearing Loss, Bilateral*; Hearing Loss, Sensorineural*; Humans; Motor Vehicles
  6. Irfan M, Yaroko AA, Soleh MN, Periasamy C
    Med J Malaysia, 2013 Apr;68(2):183-5.
    PMID: 23629575
    A massive goiter may constrict the trachea resulting in shortness of breath. Recurrent laryngeal nerve compression may cause vocal cord paralysis. We highlight a case of a 62- year-old female with a 30 year history of an anterior neck swelling gradually increasing in size. She presented with acute symptoms of upper airway obstruction and voice changes. Emergency thyroidectomy was performed by dividing the middle part of the gland using ultrasonic scissors. The recovery was uneventful and the patient regained normal vocal cord function post operatively.
    MeSH terms: Books; Goiter; Humans; Thyroidectomy*; Ultrasonics; Vocal Cord Paralysis*
  7. Yew KL
    Med J Malaysia, 2013 Apr;68(2):186.
    PMID: 23629576
    MeSH terms: Coronary Vessels*; Humans; Mucocutaneous Lymph Node Syndrome*
  8. Sahathevan R, Wan Yahya WNN, Tan HJ, Mohd Ibrahim N
    Med J Malaysia, 2013 Apr;68(2):187-8.
    PMID: 23629577
    MeSH terms: Humans; Urea*; Stroke*
  9. Ong HT, Ong LM, Tan TE, Chean KY
    Med J Malaysia, 2013 Apr;68(2):189-94.
    PMID: 23629578 MyJurnal
    The clycoxygenase (COX) enzyme forms locally active prostaglandins responsible for producing inflammation and pain. Classical non-steroidal anti-inflammatory drugs (NSAID) inhibit the COX-2 enzyme that produces inflammatory prostaglandins as well as the COX-1 enzyme that produces gastric mucosa protecting prostaglandins. By specifically inhibiting only the COX-2 enzyme, coxibs thus reduce pain but do not damage the gastric mucosa. However, COX-2 at the vascular endothelium produces antithrombotic prostaglandins, and so by inhibiting COX-2 enzyme, the coxibs promote thrombosis. Rofecoxib and valdecoxib have been withdrawn because of the adverse cardiovascular events they induce. Amongst presently available coxibs cardiovascular risk is highest with enterocoxib and lowest with celecoxib. NSAIDS also increase cardiovascular events, the risk is highest with diclofenac and lowest with naproxen. Paracetamol and corticosteroids induce hypertension, while steroids also adversely affect the heart from metabolic change as well as fluid retention. Aspirin is an anti-thrombotic agent because of its ability to inhibit the COX-1 enzyme that produces the pro-aggregatory thromboxane. However, it increases gastrointestinal bleeding, can promote fluid retention and is nephrotoxic, all of which may lead to adverse cardiovascular outcomes. Patients at especially high risk of cardiovascular events from analgesic use include the elderly, and those with heart failure, hypertension, rheumatoid arthritis, chronic renal disease, chronic obstructive airway disease and previous myocardial infarction, cerebrovascular disease or peripheral vascular disease. Adverse cardiovascular events can occur within a week of initiation of analgesic treatment.
    MeSH terms: Anti-Inflammatory Agents, Non-Steroidal; Cardiovascular Diseases*; Humans; Pain; Risk Factors; Cyclooxygenase 2 Inhibitors*
  10. Choon DS
    J Orthop Surg (Hong Kong), 2013 Apr;21(1):3.
    PMID: 23629977
    MeSH terms: Female; Humans; Male; Patella/anatomy & histology*
  11. Alhoot MA, Rathinam AK, Wang SM, Manikam R, Sekaran SD
    Int J Med Sci, 2013;10(6):719-29.
    PMID: 23630436 DOI: 10.7150/ijms.5037
    Despite the importance of DENV as a human pathogen, there is no specific treatment or protective vaccine. Successful entry into the host cells is necessary for establishing the infection. Recently, the virus entry step has become an attractive therapeutic strategy because it represents a barrier to suppress the onset of the infection. Four putative antiviral peptides were designed to target domain III of DENV-2 E protein using BioMoDroid algorithm. Two peptides showed significant inhibition of DENV when simultaneously incubated as shown by plaque formation assay, RT-qPCR, and Western blot analysis. Both DET4 and DET2 showed significant inhibition of virus entry (84.6% and 40.6% respectively) using micromolar concentrations. Furthermore, the TEM images showed that the inhibitory peptides caused structural abnormalities and alteration of the arrangement of the viral E protein, which interferes with virus binding and entry. Inhibition of DENV entry during the initial stages of infection can potentially reduce the viremia in infected humans resulting in prevention of the progression of dengue fever to the severe life-threatening infection, reduce the infected vector numbers, and thus break the transmission cycle. Moreover these peptides though designed against the conserved region in DENV-2 would have the potential to be active against all the serotypes of dengue and might be considered as Hits to begin designing and developing of more potent analogous peptides that could constitute as promising therapeutic agents for attenuating dengue infection.
    MeSH terms: Antiviral Agents/administration & dosage*; Antiviral Agents/chemical synthesis; Dengue/drug therapy; Dengue/genetics*; Dengue/virology; Dengue Virus/drug effects*; Dengue Virus/pathogenicity; Humans; Peptides/administration & dosage*; Peptides/chemical synthesis; Peptides/genetics; Viral Envelope Proteins/chemical synthesis; Viral Envelope Proteins/genetics; Virus Internalization/drug effects
  12. Nazri M, Bux SI, Tengku-Kamalden TF, Ng KH, Sun Z
    Quant Imaging Med Surg, 2013 Apr;3(2):82-8.
    PMID: 23630655 DOI: 10.3978/j.issn.2223-4292.2013.03.06
    To investigate the prevalence of incidental sinus abnormalities on CT and MRI imaging of the head, and identify if there is any correlation between patient symptomatology and image findings.
    MeSH terms: Head; Humans; Magnetic Resonance Imaging; Paranasal Sinuses; Tomography, X-Ray Computed; Prevalence
  13. Elsaid Ali AA, Taher M, Mohamed F
    J Microencapsul, 2013;30(8):728-40.
    PMID: 23631380 DOI: 10.3109/02652048.2013.788081
    Documented to exhibit cytotoxicity and poor oral bioavailability, alpha-mangostin was encapsulated into PLGA microspheres with optimization of formulation using response surface methodology. Mixed levels of four factors Face central composite design was employed to evaluate critical formulation variables. With 30 runs, optimized formula was 1% w/v polyvinyl alcohol, 1:10 ratio of oil to aqueous and sonicated at 2 and 5 min time for primary and secondary emulsion, respectively. Optimized responses for encapsulation efficiency, particle size and polydispersity index were found to be 39.12 ± 0.01%, 2.06 ± 0.017 µm and 0.95 ± 0.009, respectively, which matched values predicted by mathematical models. About 44.4% of the encapsulated alpha-mangostin was released over 4 weeks. Thermal analysis of the microspheres showed physical conversion of alpha-mangostin from crystallinity to amorphous with encapsulated one had lower in vitro cytotoxicity than free alpha-mangostin. Aerodynamic diameter (784.3 ± 7.5 nm) of this alpha-mangostin microsphere suggests suitability for peripheral pulmonary delivery.
    MeSH terms: Administration, Inhalation; Carcinoma, Non-Small-Cell Lung/drug therapy; Drug Carriers/chemistry*; Drug Compounding/methods; Humans; Lung Neoplasms/drug therapy; Particle Size; Polyglycolic Acid/chemistry*; Lactic Acid/chemistry*; Xanthones/administration & dosage*; Xanthones/pharmacology; Cell Line, Tumor; Protein Kinase Inhibitors/administration & dosage*; Protein Kinase Inhibitors/pharmacology
  14. Ramly M, Moy FM, Pendek R, Suboh S, Tan Tong Boon A
    BMC Public Health, 2013 May 01;13:416.
    PMID: 23631804 DOI: 10.1186/1471-2458-13-416
    BACKGROUND: Besides its classical role in musculoskeletal diseases, vitamin D deficiency has recently been found to be associated with cardiometabolic risks such as hypertension, diabetes mellitus and hypercholesterolemia. Although Malaysia is a sunshine-abundant country, recent studies found that vitamin D deficiency prevalence was significantly high. However, few published studies that measured its effect on cardiometabolic risk factors were found in Malaysia. There are also limited clinical trials carried out globally that tried to establish the causality of vitamin D and cardiometabolic risks. Therefore, a double blind, parallel, randomized controlled trial on vitamin D and cardiometabolic risks is planned to be carried out.The objective of this study is to investigate whether vitamin D supplements can reduce the cardiometabolic risk and improve the quality of life in urban premenopausal women with vitamin D deficiency.

    METHODS/DESIGN: Three hundred and twenty premenopausal women working in a public university in Kuala Lumpur, Malaysia will be randomized to receive either vitamin D supplement (50,000 IU weekly for 8 weeks and 50,000 IU monthly for 10 months) or placebo for 12 months. At baseline, all participants are vitamin D deficient (≤ 20 ng/ml or 50 nmol/l). Both participants and researchers will be blinded. The serum vitamin D levels of all participants collected at various time points will only be analysed at the end of the trial. Outcome measures such as 25(OH) D3, HOMA-IR, blood pressure, full lipid profiles will be taken at baseline, 6 months and 12 months. Health related quality of life will be measured at baseline and 12 months. The placebo group will be given delayed treatment for six months after the trial.

    DISCUSSION: This trial will be the first study investigating the effect of vitamin D supplements on both the cardiometabolic risk and quality of life among urban premenopausal women in Malaysia. Our findings will contribute to the growing body of knowledge in the role of vitamin D supplements in the primary prevention for cardiometabolic disease.

    TRIAL REGISTRATION: ACTRN12612000452897.

    MeSH terms: Adult; Cardiovascular Diseases/prevention & control*; Double-Blind Method; Female; Health Status Indicators; Humans; Malaysia; Metabolic Diseases/prevention & control; Quality of Life; Risk Factors; Urban Population; Vitamin D/administration & dosage*; Vitamin D Deficiency/drug therapy; Vitamin D Deficiency/psychology; Exercise/psychology; Premenopause; Dietary Supplements*
  15. Chai LK, Wong MH, Bruun Hansen HC
    J Environ Manage, 2013 Aug 15;125:28-32.
    PMID: 23632002 DOI: 10.1016/j.jenvman.2013.04.005
    The insecticide chlorpyrifos is extensively used in the humid tropics for insect control on crops and soils. Chlorpyrifos degradation and mineralization was studied under laboratory conditions to characterize the critical factors controlling the degradation and mineralization in three humid tropical soils from Malaysia. The degradation was fastest in moist soils (t1/2 53.3-77.0 days), compared to dry (t1/2 49.5-120 days) and wet soils (t1/2 63.0-124 days). Degradation increased markedly with temperature with activation energies of 29.0-76.5 kJ mol(-1). Abiotic degradation which is important for chlorpyrifos degradation in sub-soils containing less soil microbial populations resulted in t½ of 173-257 days. Higher chlorpyrifos dosages (5-fold) which are often applied in the tropics due to severe insects infestations caused degradation and mineralization rates to decrease by 2-fold. The mineralization rates were more sensitive to the chlorpyrifos application rates reflecting that degradation of metabolites is rate limiting and the toxic effects of some of the metabolites produced. Despite that chlorpyrifos is frequently used and often in larger amounts on tropical soils compared with temperate soils, higher temperature, moderate moisture and high activity of soil microorganisms will stimulate degradation and mineralization.
    MeSH terms: Chlorpyrifos/chemistry*; Insecticides/chemistry*; Soil/chemistry*; Soil Pollutants/chemistry*; Temperature
  16. Badrin O, Kushairi S, Zakaria Z, Sachithanandan A
    BMJ Case Rep, 2013;2013.
    PMID: 23632185 DOI: 10.1136/bcr-2013-009112
    Heparin resistance (HR) is an increasingly common occurrence due to a greater awareness of the benefits of antithrombosis prophylaxis in hospitalised patients with low molecular weight and unfractionated heparin. Furthermore as more high-risk patients with prior heparin exposure undergo cardiac surgery we can expect to encounter more such cases. Adequate anticoagulation is essential for the safe conduct of any operation requiring cardiopulmonary bypass and is usually achieved with systemic heparinisation. We report a case of successful anticoagulation with the intraoperative administration of fresh frozen plasma in a high-risk coronary patient with HR and highlight the perils of unwitting overheparinisation in such cases. This case highlights the importance of clinical awareness of this phenomenon and the available alternative anticoagulants.
    MeSH terms: Angina, Unstable/surgery*; Angina, Unstable/ultrasonography; Anticoagulants/adverse effects; Anticoagulants/therapeutic use*; Cardiopulmonary Bypass*; Echocardiography; Heparin/adverse effects; Heparin/therapeutic use*; Humans; Male; Middle Aged; Plasma*
  17. Quah CK, Fun HK, Suwunwong T, Boonnak N, Chantrapromma S
    Acta Crystallogr Sect E Struct Rep Online, 2013 Apr 1;69(Pt 4):o464-5.
    PMID: 23634024 DOI: 10.1107/S1600536813005369
    The asymmetric unit of the title compound, C18H18ClN3OS·C2H5OH, comprises a pyrazoline derivative and an ethanol solvent mol-ecule. In the mol-ecule of the pyrazoline derivative, the pyrazole ring adopts an envelope conformation with the C atom bearing the eth-oxy-phenyl substituent as the flap. The dihedral angle between the benzene rings is 74.22 (7)°. The eth-oxy group is coplanar with the attached benzene ring [C-O-C-Cmeth-yl = 175.50 (11)° and r.m.s. deviation = 0.0459 (1) Å for the nine non-H atoms]. In the crystal, the pyrazoline mol-ecules are linked by N-H⋯Oeth-oxy hydrogen bonds into chains along the c axis and are further linked with the solvent ethanol mol-ecules by N-H⋯Oethanol and Oethanol-H⋯S hydrogen bonds. C-H⋯π inter-actions are also present.
  18. Taha M, Ismail NH, Jaafar FM, Aziz AN, Yousuf S
    PMID: 23634042 DOI: 10.1107/S1600536813005692
    In the title compound, C16H16N2O3·H2O, the dihedral angle between the benzene rings is 30.27 (7)°. In the crystal, the components are linked by N-H⋯O, O-H⋯O and C-H⋯O inter-actions into a three-dimensional network.
  19. Fun HK, Chidan Kumar CS, Patrao P, Khader AM, Kalluraya B
    Acta Crystallogr Sect E Struct Rep Online, 2013 Apr 1;69(Pt 4):o491-2.
    PMID: 23634043 DOI: 10.1107/S1600536813005837
    The asymmetric unit of the title compound, C26H18N6O4S, contains two independent mol-ecules (A and B). The dihedral angles between the oxadiazole ring and naphthalene ring system are 42.59 (14) and 6.88 (14) Å in mol-ecules A and B, respectively. The dihedral angles between the pyridine and benzene rings in A and B are 65.53 (13 )and 87.67 (13) Å, respectively. In the crystal, mol-ecules A and B are linked through a pair of N-H⋯N hydrogen bonds involving one -NH2 group H atom and second pair of N-H⋯N hydrogen bonds involving the other -NH2 group H atom, forming an -ABAB- ribbon along [100] containing R 2 (2)(8) and R 2 (2)(12) ring motifs. These ribbons are further connected by weak C-H⋯N, C-H⋯O and C-H⋯π inter-actions, resulting in a three-dimensional network. The crystal studied was a non-merohedral twin with refined components 0.906 (1):0.094 (1).
  20. Fun HK, Quah CK, Aich K, Das S, Goswami S
    PMID: 23634050 DOI: 10.1107/S1600536813005539
    In the title compound, C13H12O5, the mean plane of the 2H-chromene ring system (r.m.s deviation = 0.026 Å) forms a dihedral angle of 81.71 (6)° with the mean plane of ethyl 2-hy-droxy-acetate moiety (r.m.s deviation = 0.034 Å). In the crystal, C-H⋯O hydrogen bonds result in the formation of zigzag layers parallel to the bc plane.
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