Browse publications by year: 2014

  1. Fulltext Urogenital melioidosis: a review of clinical presentations, characteristic and outcomes
    Chong Vh VH, Sharif F, Bickle I
    Med J Malaysia, 2014 Dec;69(6):257-60.
    PMID: 25934955 MyJurnal
    INTRODUCTION: Melioidosis is endemic to the tropical regions, in particular Thailand and Northern Australia. Any organ can be affected by melioidosis. Involvement of the urogenital system is common in Northern Australia, but is less common in other regions. This study assesses the characteristics of melioidosis affecting the urogenital system treated in a tertiary referral centre in Brunei Darussalam.

    MATERIAL AND METHODS: All patients treated for melioidosis of the urogenital system were identified and retrospectively reviewed.

    RESULTS: There were 9 patients with 11 episodes of urogenital infections treated over 13 years. The median age at diagnosis was 38 years old (range 29 - 63) with men predominantly affected. The major risk factor was underlying diabetes mellitus (n=9), including three patients diagnosed at the time of diagnosis of melioidosis. The median glycosylated haemoglobin (HbA1c) was 12.8% (range 6.4 to 16.6%). One patient's risk factor was only moderate alcohol consumption. Common symptoms included; fever, lethargy, rigor and anorexia. Dysuria was reported by two patients. The median duration of symptoms before presentation was 7 days (range 2 to 21 days) and the median number of sites involved were 3 (range of 2 to 6). Urogenital involvement included prostate (n=6), kidney (n=8), seminal vesicles (n=1) and testis (n=1). Radiological imaging showed that large prostate abscesses (>4.5cm) were common, and in some patients, the kidney abscess had the 'honeycomb' previously described as typical for melioidosis liver abscess. All patients were successfully treated for melioidosis and at a median follow up of 34 months (range 1 - 97), there was one death from complications of diabetes mellitus.

    CONCLUSION: Urogenital melioidosis only accounted for a small proportion of all melioidosis involvement, with prostate and kidney most commonly affected. Concomitant involvement of other sites were common. The major risk factor was poorly controlled diabetes mellitus.
    MeSH terms: Adult; Alcohol Drinking; Anorexia; Australia; Brunei; Diabetes Mellitus; Fever; Follow-Up Studies; Humans; Liver Abscess; Male; Melioidosis; Middle Aged; Prostate; Retrospective Studies; Risk Factors; Seminal Vesicles; Testis; Thailand; Urinary Tract Infections; Chills; Diabetes Complications; Dysuria; Lethargy; Tertiary Care Centers
  2. Fulltext Brain and spinal tumour
    Goh CH, Lu YY, Lau BL, Oy J, Lee HK, Liew D, et al.
    Med J Malaysia, 2014 Dec;69(6):261-7.
    PMID: 25934956 MyJurnal
    This study reviewed the epidemiology of brain and spinal tumours in Sarawak from January 2009 till December 2012. The crude incidence of brain tumour in Sarawak was 4.6 per 100,000 population/year with cumulative rate 0.5%. Meningioma was the most common brain tumour (32.3%) and followed by astrocytoma (19.4%). Only brain metastases showed a rising trend and cases were doubled in 4 years. This accounted for 15.4% and lung carcinoma was the commonest primary. Others tumour load were consistent. Primitive neuroectodermal tumour (PNET) and astrocytoma were common in paediatrics (60%). We encountered more primary spinal tumour rather than spinal metastases. Intradural schwannoma was the commonest and frequently located at thoracic level. The current healthcare system in Sarawak enables a more consolidate data collection to reflect accurate brain tumours incidence. This advantage allows subsequent future survival outcome research and benchmarking for healthcare resource planning.
    MeSH terms: Astrocytoma; Brain; Brain Neoplasms; Child; Humans; Malaysia; Meningeal Neoplasms; Meningioma; Neurilemmoma; Pediatrics; Spinal Cord Neoplasms; Incidence; Neuroectodermal Tumors, Primitive; Benchmarking; Tumor Burden
  3. Fulltext A snapshot of stroke from Miri Hospital
    Grover CS, Thiagarajah S
    Med J Malaysia, 2014 Dec;69(6):268-72.
    PMID: 25934957 MyJurnal
    Our objective was to study the profile of cerebrovascular accidents and proportion of cerebral haemorrhage (CH) among stroke patients. This project was designed after we observed higher incidence of CH in Miri hospital as compared to conventionally reported data.

    METHODS: This was a prospective observational study conducted from 1st June 2008 to 31st May 2009. All patients admitted in both male and female wards of the Medical Unit with the first incidence of a stroke were recruited for analysis. CT scan brain was done in all patients.

    RESULTS: Total admissions in one year in the medical department were 3204 patients, both male and female together, out of which 215 were due to a first incidence of stroke; Stroke accounted for 6.7% of admissions and 16.8% of deaths in medical unit. 139 (64.7%) were ischaemic strokes and 76 (35.3%) were cerebral haemorrhages. The incidence of CH (35.3%) was high compared to regional data. 71.7% (154) patients had preexisting hypertension. Higher incidence of hypertension, diabetes mellitus and aspirin intake was noted in the ischaemic group. Also compliance to treatment for hypertension was better in the Ischaemic group with more defaults in CH category (P<0.01). Significantly more deaths were noted in patients with higher systolic blood pressure on presentation, poor Glasgow Coma Scale (GCS) and those with dysphagia.

    CONCLUSION: Every third stroke was due to cerebral hemorrhage; CH patients were largely unaware of their hypertension or were altogether treatment naïve or defaulters while compliance was far better in ischaemic stroke category.
    MeSH terms: Aspirin; Blood Pressure; Brain; Cerebral Hemorrhage; Deglutition Disorders; Diabetes Mellitus; Female; Humans; Hypertension; Male; Prospective Studies; Tomography, X-Ray Computed; Glasgow Coma Scale; Incidence; Stroke
  4. Fulltext Giant lipomatous lesion of the thigh with retroperitoneal extension: case series
    Khang NC, Ahmad Rafizi H, Zainal Ariffin A, Chye PC
    Med J Malaysia, 2014 Dec;69(6):273-4.
    PMID: 25934958 MyJurnal
    Giant lipomatous lesions of the thigh swelling with extension into retroperitoneum are rare. Lesions can be malignant or benign and can have similar clinical presentation. Treatments options differ and their prognosis varies with histology. We present two cases of liposarcoma and lipoma with the same clinical presentations that underwent surgical resection.
    MeSH terms: Lipoma; Liposarcoma; Prognosis; Thigh
  5. Fulltext A Testicular Cancer that was Thought to be an Inguino-Scrotal Hernia
    Norly S, Sivanes C, Ros'aini P
    Med J Malaysia, 2014 Dec;69(6):275-6.
    PMID: 25934959
    We present a case of a young man with a 5-year history of testicular swelling which was initially thought to be inguinoscrotal hernia. Intra-operatively it was found to be a testicular tumour and histopathological examination confirmed a mixed germ cell tumour. He had an orchidectomy and later underwent chemotherapy. It is interesting to note that the patient had kept the tumour for 5 years with no evidence of distant metastasis at diagnosis. This is probably the longest presentation of a testicular tumour.
    MeSH terms: Hernia; Humans; Male; Neoplasms, Germ Cell and Embryonal; Orchiectomy; Testicular Neoplasms
  6. Fulltext Congenital mastoid cholesteatoma presenting as a mass obstructing external auditory canal
    Khairunnisak M, Mohd Khairi MD
    Med J Malaysia, 2014 Dec;69(6):277-8.
    PMID: 25934960 MyJurnal
    We describe the clinical presentation, investigation and management of an eventually fatal case of hypercalcemic crisis due to primary hyperparathyridism (PHPT). A 60 year-old lady with history of urolithiasis presented with worsening generalized bone pain, spinal scoliosis and a limp. Laboratory data showed hypercalcemia and raised alkaline phosphatase. Left hip x-ray revealed a subcapital femoral neck fracture. Intact parathyroid hormone was elevated, 187.6 pmol/L (1.6 - 6.9) and ultrasound showed an enlarged right parathyroid gland. Despite initial reduction of serum calcium with saline infusion and multiple doses of intravenous pamidronate, her calcium increased to 4.14 mmol/L a week following application of Buck's traction for persistent left hip pain. She succumbed eventually with serum calcium peaking at 6.28 mmol/L despite multiple therapeutic interventions.
    MeSH terms: Alkaline Phosphatase; Calcium; Calcium, Dietary; Diphosphonates; Female; Femoral Neck Fractures; Hypercalcemia; Pain; Parathyroid Diseases; Parathyroid Glands; Parathyroid Hormone; Scoliosis; Traction; X-Rays; Urolithiasis
  7. Fulltext Kimura's Disease: Diagnostic Challenge and Treatment Modalities
    Sia KJ, Kong CK, Tan TY, Tang IP
    Med J Malaysia, 2014 Dec;69(6):281-3.
    PMID: 25934961
    CASE REPORT: Five cases of Kimura's disease had been treated in our centre from year 2003 to 2010. All cases were presented with head and neck mass with cervical lymphadenopathy. Surgical excision was performed for all cases. Definite diagnosis was made by histopathological examination of the resected specimens. One out of five cases developed tumour recurrence four years after resection.

    CONCLUSION: Surgical excision is our choice of treatment because the outcome is immediate and definite tissue diagnosis is feasible after resection. Oral corticosteroid could be considered as an option in advanced disease. However, tumour recurrence is common after cessation of steroid therapy.
    MeSH terms: Adrenal Cortex Hormones; Angiolymphoid Hyperplasia with Eosinophilia; Neoplasms; Recurrence; Lymphadenopathy
  8. Fulltext Shewanella dysentery in a patient with underlying malignancy
    Jeffery S
    Med J Malaysia, 2014 Dec;69(6):284-5.
    PMID: 25934962 MyJurnal
    Shewanella spp is a facultatively anaerobic, motile, gramnegative bacillus and can be found throughout the world mainly in marine environments and soil. It is a rare pathogen in human and infection by it is usually associated with underlying severe morbidities. We report a case of a 69- years old woman who presented with Shewanella putrefaciens dysentery and who was subsequently found to have underlying malignancy.
    MeSH terms: Aged; Bacillus; Dysentery; Environment; Female; Gram-Negative Facultatively Anaerobic Rods; Humans; Morbidity; Neoplasms; Soil; Shewanella; Shewanella putrefaciens
  9. Fulltext Colon cancer recurrence mimicking renal cell carcinoma
    Yusoff AR, Aripin YM, Zuhanis AH
    Med J Malaysia, 2014 Dec;69(6):286-7.
    PMID: 25934963 MyJurnal
    No abstract available.
    MeSH terms: Humans
  10. Fulltext Spontaneous intracranial haemorrhage in children with chronic immune thrombocytopenic purpura
    Muda Z, Ibrahim H, Abdulrahman EJ, Mahfuzah M, Othman IS, Asohan T, et al.
    Med J Malaysia, 2014 Dec;69(6):288-90.
    PMID: 25934964 MyJurnal
    Spontaneous intracranial haemorrhage (ICH) is a rare complication of chronic immune thrombocytopenic purpura (ITP) in children. We report four patients with cITP who developed ICH. The latency between onset of ITP and ICH varied from 1-8 years. All our patients were profoundly thrombocytopenic (platelet count of <10 x 109/l) at the time of their intracranial bleed. The presenting features and management are discussed. All patients survived, three had complete neurological recovery while one had a minimal residual neurological deficit.
    MeSH terms: Child; Chronic Disease; Hemorrhage; Humans; Malaysia; Platelet Count; Purpura, Thrombocytopenic, Idiopathic; Intracranial Hemorrhages
  11. Fulltext Abdominal stab wound with inferior vena cava injury: a case report
    Narasimman S, Tan WJ
    Med J Malaysia, 2014 Dec;69(6):291-2.
    PMID: 25934965 MyJurnal
    MeSH terms: Humans
  12. Fulltext Ectopic inferior vena cava thrombus secondary to a tubo-ovarian abscess
    Koh KS, Abdullah NA, Chong VH
    Med J Malaysia, 2014 Dec;69(6):293-5.
    PMID: 25934966
    Inferior vena cava (IVC) thrombosis typically arises distally from a thrombophlebitic extension in the pelvis or the lower extremities. It may also occur from propagation of an ovarian vein thrombosis as a result of gynaecological disorders such as pelvic inflammatory disease, endometritis or from pelvic surgeries. In this report, we present an interesting case of a tubo-ovarian abscess with an ectopic IVC thrombus. The approach to management in such cases is also highlighted.
    MeSH terms: Abscess; Pelvic Inflammatory Disease; Brunei; Endometritis; Female; Humans; Oophoritis; Pelvis; Thrombophlebitis; Vena Cava, Inferior; Venous Thrombosis; Lower Extremity
  13. Fulltext Neuroscience and Brain Science Special Issue begins in the Malaysian Journal of Medical Sciences
    Abdullah JM
    Malays J Med Sci, 2014 Dec;21(Spec Issue):1-5.
    PMID: 25941457
    The Malaysian Journal of Medical Sciences and the Orient Neuron Nexus have amalgated to publish a yearly special issue based on neuro- and brain sciences. This will hopefully improve the quality of peer-reviewed manuscripts in the field of fundamental, applied, and clinical neuroscience and brain science from Asian countries. One focus of the Universiti Sains Malaysia is to strengthen neuroscience and brain science, especially in the field of neuroinformatics.
    MeSH terms: Asia; Brain; Malaysia; Neurology; Neurons; Neurosciences; Peer Review; Resin Cements
  14. Evaluation of the Cytotoxicity of Levodopa and its Complex with Hydroxypropyl-ß-Cyclodextrin (HP-ß-CD) to an Astrocyte Cell Line
    Sofian ZM, Shafee SS, Abdullah JM, Osman H, Razak SA
    Malays J Med Sci, 2014 Dec;21(Spec Issue):6-11.
    PMID: 25941458
    A simple, reliable a 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxy-phenyl)-2-(4-sulfophenyl)-2H-tetrazolium, (MTS) assay was conducted to evaluate the potential cytotoxic effects of levodopa, a "gold standard therapy" for Parkinsonism, and its complex with Hydroxypropyl-β-Cyclodextrin (HP-β-CD) on an astrocyte cell line. The cells were incubated in a range of concentrations from 4.69 to 300 μg/mL levodopa, HP-β-CD or the complex for up to 72 hours. At every 24-hour interval, the optical density (OD), which reflects the number of viable cells, was recorded. In general, linear dose-dependent cytotoxicity profiles were observed for the cells subjected to levodopa or the complex, whereas a slightly triphasic response was observed for the cells exposed to HP-β-CD. A significant difference (P < 0.05) in cytotoxicity was detected between the HP-β-CD-treated group and the levodopa-treated group. In particular, we observed that the cells treated with the complex, even at the highest concentrations (> 200 μg/mL), exhibited improved tolerability in a time-dependent manner, which may indicate the potential ability of HP-β-CD to mask the toxic effects of levodopa via complexation.
  15. In vivo Electrochemical Biosensor for Brain Glutamate Detection: A Mini Review
    Hamdan SK, Mohd Zain A
    Malays J Med Sci, 2014 Dec;21(Spec Issue):12-26.
    PMID: 25941459 MyJurnal
    Glutamate is one of the most prominent neurotransmitters in mammalian brains, which plays an important role in neuronal excitation. High levels of neurotransmitter cause numerous alterations, such as calcium overload and the dysfunction of mitochondrial and oxidative stress. These alterations may lead to excitotoxicity and may trigger multiple neuronal diseases, such as Alzheimer's disease, stroke, and epilepsy. Excitotoxicity is a pathological process that damages nerve cells and kills cells via excessive stimulation by neurotransmitters. Monitoring the concentration level of brain glutamate via an implantable microbiosensor is a promising alternative approach to closely investigate in the function of glutamate as a neurotransmitter. This review outlines glutamate microbiosensor designs to enhance the sensitivity of glutamate detection with less biofouling occurrence and minimal detection of interference species. There are many challenges in the development of a reproducible and stable implantable microbiosensor because many factors and limitations may affect the detection performance. However, the incorporation of multiple scales is needed to address the basic issues and combinations across the various disciplines needed to achieve the success of the system to overcome the challenges in the development of an implantable glutamate biosensor.
  16. Fulltext MiR-3099 is Overexpressed in Differentiating 46c Mouse Embryonic Stem Cells upon Neural Induction
    Zainal Abidin S, Abbaspourbabaei M, Ntimi CM, Siew WH, Pike-See C, Rosli R, et al.
    Malays J Med Sci, 2014 Dec;21(Spec Issue):27-33.
    PMID: 25941460 MyJurnal
    MicroRNAs (miRNAs) have a crucial role in gene expression regulation and protein synthesis, especially in the central nervous system. In developing mouse embryos a novel miRNA, miR-3099, is highly expressed, particularly in the central nervous system. This study aims to determine the expression of miR-3099 during cellular differentiation of 46C mouse embryonic stem cells after neural induction with N2/B27 medium.
    MeSH terms: Mouse Embryonic Stem Cells; Animals; Cell Differentiation; Central Nervous System; Gene Expression Regulation; Protein Biosynthesis; MicroRNAs; Embryonic Development; Mice
  17. Fulltext Age-dependent Electroencephalographic Differences in the Genetic Absence Epilepsy Rats from Strasbourg (GAERS) Model of Absence Epilepsy
    Islam MR, Abdullah JM
    Malays J Med Sci, 2014 Dec;21(Spec Issue):34-40.
    PMID: 25941461 MyJurnal
    Genetic Absence Epilepsy Rats from Strasbourg (GAERS) are a prognostic genetic model of absence epilepsy. This model displays the electro-clinical, behavioural, and pharmacological features of absence seizures. Although GAERS share typical characteristics, including spike-and-wave discharges (SWDs) in the electroencephalography (EEG), age-dependent studies with these animals have not yet been reported. The aim of the present study is to perform a systematic comparison contrasting the SWDs of young and older GAERS, in terms of the number, duration, frequency, and waveform morphology of the discharges, as well as the pre-SWD EEG characteristics, using identical measurement and analysis techniques. The number, cumulative total duration and mean duration of SWDs were significantly higher in young GAERS (4 to 6 months) compared to older GAERS (12 to 14 months). Furthermore, the SWD spectra and average SWD waveforms indicated that a single cycle of the SWD contains more energy in faster components, such as increased spikes and higher power, in the SWDs of the young GAERS. Additionally, older GAERS showed weak amplitude spikes in SWDs and higher power pre-SWDs. These clear morphological differences in the EEGs of young and older GAERS rats should be further examined in future studies that explore new dimensions of genetic absence epilepsy.
    MeSH terms: Animals; Disease Models, Animal; Electroencephalography; Epilepsy, Absence; Models, Genetic; Prognosis; Seizures; Rats
  18. Fulltext The brain in pain
    Ahmad AH, Abdul Aziz CB
    Malays J Med Sci, 2014 Dec;21(Spec Issue):46-54.
    PMID: 25941463 MyJurnal
    Pain, while salient, is highly subjective. A sensation perceived as painful by one person may be perceived as uncomfortable, not painful or even pleasant to others. Within the same person, pain may also be modulated according to its threat value and the context in which it is presented. Imaging techniques, such as functional magnetic resonance imaging and positron emission tomography, have identified a distributed network in the brain, the pain-relevant brain regions, that encode the sensory-discriminative aspect of pain, as well as its cognitive and affective/emotional factors. Current knowledge also implicates the prefrontal cortex as the modulatory area for pain, with its subdivisions forming the cortico-cortical pathway, an alternative pain modulatory pathway distinct from the descending modulatory pathway of pain. These findings from neuroimaging in human subjects have paved the way for the molecular mechanisms of pain modulation to be explored in animal studies.
    MeSH terms: Animals; Brain; Cognition; Emotions; Humans; Magnetic Resonance Imaging; Pain; Sensation; Prefrontal Cortex; Research Subjects; Positron-Emission Tomography; Neuroimaging
  19. Abstracts of orient neuron nexus 1(1), 2(1), and 3(1)
    Malays J Med Sci, 2014 Dec;21(Spec Issue):55-8.
    PMID: 25941464
  20. Fulltext Insulin resistance using HOMA model in obstructive sleep apnea: a cross sectional study
    Azman M, Sani A, Kamaruddin NA
    Ann Saudi Med, 2014;34(6):476-81.
    PMID: 25971819 DOI: 10.5144/0256-4947.2014.476
    BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) is a common disease affecting middle-aged patients and is associated with significant cardiovascular, cerebrovascular, and metabolic complications. Current evidences show inconclusive association between OSA and insulin resistance (IR). This study aims to examine the possible correlation between OSA parameters and IR.

    DESIGN AND SETTINGS: This was a cross-sectional study to examine the association between OSA parameters and IR using homeostasis model assessment (HOMA) on patients who underwent polysomnogram (PSG) in a tertiary center between March 2011 and March 2012 (1 year).

    PATIENTS AND METHODS: A total of 62 patients underwent PSG within the study period, of which 16 patients were excluded due to abnormal fasting blood sugar. Information on patients' medical illnesses, medications, and Epworth sleepiness scale (ESS) was obtained. Patients' body mass index (BMI), neck circumference, and waist circumference (WC) were measured. Blood samples were collected after 8 hours of fasting to measure HOMA-IR value. Overnight PSG was performed for all patients. Data was recorded and analyzed using SPSS, version 12.0 (SPSS Inc, Chicago, USA).

    RESULTS: The prevalence of IR in OSA patients was 64.3%. There was significant correlation between OSA parameters (apnea-hypopnea index, ESS, BMI, and WC) and HOMA-IR with correlation coefficient of 0.529, 0.224, 0.261, and 0.354, respectively.

    CONCLUSION: A linear correlation exists between OSA parameters and IR concluding a definite causal link between OSA and IR. IR screening is recommended in severe OSA patients.

    MeSH terms: Adult; Blood Glucose/metabolism*; Cross-Sectional Studies; Female; Humans; Insulin/metabolism*; Insulin Resistance*; Male; Middle Aged; Obesity/complications; Obesity/metabolism*; Severity of Illness Index; Body Mass Index; Linear Models; Polysomnography; Sleep Apnea, Obstructive/complications; Sleep Apnea, Obstructive/metabolism*; Sleep Apnea, Obstructive/physiopathology; Waist Circumference
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