Browse publications by year: 2017

  1. Lye MS, Tohit NF, Rampal L
    Med J Malaysia, 2017 02;72(1):12-17.
    PMID: 28255134 MyJurnal
    INTRODUCTION: Pediculosis capitis infestation is endemic in both developing and developed countries leading to various physical, economical and psychological consequences. Our main objective was to determine the prevalence and predictors of pediculosis capitis among primary school children in Hulu Langat District, Malaysia.

    METHODS: An analytic cross-sectional study using cluster random sampling method was carried out in Hulu Langat District, Malaysia. Self-administered pretested questionnaires were used to collect the data. Hair and scalp examination was also carried out. Multivariate logistic regression was used to control for potential confounding and determine the predictors.

    RESULTS: The overall mean age of the 1,336 respondents was 9.3 years. Majority were males (52.8%), Malays (79.5%) and 81.3% of the fathers had secondary or tertiary education as compared to 77.3% for the mothers. The overall prevalence of pediculosis capitis was 15.3%. The prevalence of pediculosis was significantly higher among females (28.4%) than males (3.7%, p=0.001). Multivariate logistic regression analysis showed that age 10 years or more (Odds Ratio (OR) = 2.34, 95% Confidence Interval (CI) = 1.673 to 3.272), female gender (OR = 10.26, 95% CI = 6.620 to 15.903), history of contact with an infested person (OR = 2.11, 95% CI = 1.506 to 2.960), Indian compared to Chinese (OR = 3.55, 95% CI = 1.282 to 9.860), Malay to Chinese (OR = 2.59, 95% CI = .994 to 6.774) were associated with pediculosis capitis.

    CONCLUSIONS: Prevalence of pediculosis capitis among children aged 7 - 12 years in Hulu Langat District was high. There is a need for screening and treatment of pediculosis capitis in primary schools.

    MeSH terms: Animals; Child; Cross-Sectional Studies; Fathers; Female; Hair; Humans; Malaysia; Male; Mothers; Lice Infestations; Pediculus; Surveys and Questionnaires; Scalp; Scalp Dermatoses; Schools; Prevalence; Confidence Intervals; Logistic Models; Odds Ratio; Developed Countries
  2. Teoh SH, Razlina AR, Norwati D, Siti Suhaila MY
    Med J Malaysia, 2017 02;72(1):18-25.
    PMID: 28255135
    BACKGROUND: blood pressure (bP) control among Malaysian is poor and doctor's adherence to clinical practice guideline (cPG) has been a well-known factor that may improve it. this study was designed to evaluate patients' bP control, doctors' adherence to the latest hypertension cPG and their association. Factors associated with bP control and cPG adherence was also examined.

    METHODS: A cross-sectional study was conducted in Kuala Muda district's health clinics. 331 medical records were selected using stratified random sampling and standard proforma was used for data collection. the latest edition of the Malaysian cPG on hypertension was employed to define related variables.

    RESULTS: A total of 160 patients (48.3%) had controlled bP and it was significantly associated with patients' age (adjusted Odds ratio, aOr= 1.03, 95% cI: 1.004, 1.05, p= 0.016) and systolic bP at presentation (aOr= 0.95, 95% cI: 0.93, 0.96, p< 0.001). About 60.7% of the medical records showed doctor's good level of cPG adherence. this adherence has significant association with presence of chronic kidney disease (aOr= 0.51, 95% cI: 0.31, 0.85, p= 0.007) and cardiovascular disease (aOr= 2.68, 95% cI: 1.04, 6.95, p= 0.030) in the patients and physicians' treatment intensification (aOr= 2.00, 95% cI: 1.26, 3.19, p= 0.009). However, no association was found between bP control and cPG adherence.

    CONCLUSION: Hypertension control in this study was poor and the prevalence of physicians with good level of cPG adherence was slightly above average. these findings are important for relevant stakeholders to strategise an action plan to improve hypertension management outcome.
    MeSH terms: Ambulatory Care Facilities; Blood Pressure; Blood Pressure Determination; Cardiovascular Diseases; Cross-Sectional Studies; Humans; Hypertension; Malaysia; Medical Records; Prevalence; Odds Ratio; Guideline Adherence*; Renal Insufficiency, Chronic
  3. Teh LC, Prema M, Choy MP, Letchuman GR
    Med J Malaysia, 2017 02;72(1):26-31.
    PMID: 28255136 MyJurnal
    INTRODUCTION: Specialists constitute a major 'driving force' and catalyst for growth of research in their speciality. A clearer understanding is required as to what motivates their participation in research as well as the barriers they faced. This research aims to study the attitudes, barriers and facilitators faced by specialists and to identify strategies to promote and sustain research activities in their hospitals.

    METHODOLOGY: A cross-sectional survey using selfadministered questionnaires was conducted among all specialists working in government specialist hospitals in the northern states of Malaysia.

    RESULTS: Out of 733 questionnaires distributed, 467 were returned giving a response rate of 63.7%. Ninety-nine percent of the respondents believed that research benefits patients while 93.3% think research helps in their professional development. However, 34.8% think that under their present working conditions, it is unlikely they will participate in research. The major barriers identified were lack of funds for research (81%); lack access to expertise, software or statistical analysis (78.4%); interference with daily work schedule (75.1%) and inconsistent manpower in their department (74.2%). There are three barriers with statistically significant difference between hospitals with CRC compared to hospitals without CRC; lack of funds, mentors and access to expertise, software or statistical analysis. The demographic factors, attitudes and barriers contributing to involvement in research also investigated. The main facilitators for the conduct of research are potential to benefit patients and potential for professional development.

    CONCLUSION: Taking note of the findings, the Ministry of Health can implement appropriate strategies to improve specialist participation in research.

    MeSH terms: Attitude; Cross-Sectional Studies; Demography; Financial Management; Government; Humans; Malaysia; Mentors; Motivation; Personnel Staffing and Scheduling; Surveys and Questionnaires; Software; Specialization
  4. Chong LA, Khalid F, Khoo TB, Teh SH, Kuan GL, Aina Mariana AM, et al.
    Med J Malaysia, 2017 02;72(1):32-36.
    PMID: 28255137 MyJurnal
    INTRODUCTION: Awareness for paediatric palliative care has resulted in the impetus for paediatrician-led palliative care services across Malaysia. However, there is paucity of local data on patients receiving hospital-based paediatric palliative care. We aim to review the clinical spectrum of patients referred to these services.

    METHODS: An observational study of children aged between 0-18 years receiving palliative care at 13 hospitals between 1st January and 31st December 2014 was carried out.

    RESULTS: There were 315 patients analysed, 90 (28.6%) and 46 (14.6%) were neonates and adolescents respectively. The main ICD-10 diagnostic categories for all patients were identified to be 'Congenital malformations, deformations and chromosomal abnormalities' 117 (37.1%), 'Diseases of nervous system' 76 (24.1%) and 'Neoplasms' 60 (19.0%). At referral 156 (50%) patients had holistic needs assessments. Patients with 'Diseases of nervous system' were assessed to have significantly more physical needs than the other two diagnostic categories. Majority of patients who knew of their diagnosis and prognosis were those with malignancy. Over a fifth of referrals were at their terminal admission. Of 144 who died, 111 (77.1%) had advanced care plans. There was bereavement follow-up in 98 (68.1%) patients.

    CONCLUSION: Patients referred for palliative care have varied diagnoses and needs. To ensure all paediatricians are competent to deliver quality care to all children, further education and training initiatives is imperative.

    MeSH terms: Adolescent; Bereavement; Child; Chromosome Aberrations; Death; Follow-Up Studies; Grief; Hospitals, Pediatric; Humans; Infant, Newborn; Malaysia; Neoplasms; Nervous System; Palliative Care; Prognosis; Referral and Consultation; Needs Assessment; International Classification of Diseases; Pediatricians
  5. Dzulkarnain AA, Rahmat S, Mohd Puzi NA, Badzis M
    Med J Malaysia, 2017 02;72(1):37-45.
    PMID: 28255138 MyJurnal
    INTRODUCTION: This discussion paper reviews and synthesises the literature on simulated learning environment (SLE) from allied health sciences, medical and nursing in general and audiology specifically. The focus of the paper is on discussing the use of high-fidelity (HF) SLE and describing the challenges for developing a HF SLE for clinical audiology training.

    METHODS: Through the review of the literature, this paper discusses seven questions, (i) What is SLE? (ii) What are the types of SLEs? (iii) How is SLE classified? (iv) What is HF SLE? (v) What types of SLEs are available in audiology and their level of fidelity? (vi) What are the components needed for developing HF SLE? (vii) What are the possible types of HF SLEs that are suitable for audiology training? Publications were identified by structured searches from three major databases PubMed, Web of Knowledge and PsychInfo and from the reference lists of relevant articles. The authors discussed and mapped the levels of fidelity of SLE audiology training modules from the literature and the learning domains involved in the clinical audiology courses.

    RESULTS: The discussion paper has highlighted that most of the existing SLE audiology training modules consist of either low- or medium-fidelity types of simulators. Those components needed to achieve a HF SLE for audiology training are also highlighted.

    CONCLUSION: Overall, this review recommends that the combined approach of different levels and types of SLE could be used to obtain a HF SLE training module in audiology training.

    MeSH terms: Simulation Training; Audiology; Learning; Knowledge; PubMed
  6. Muniswaran G, Soelar SA, Karalasingam SD, Bujang MA, Jeganathan R, Suharjono H
    Med J Malaysia, 2017 02;72(1):46-49.
    PMID: 28255139 MyJurnal
    INTRODUCTION: Gestational diabetes (GDM) has significant maternal and foetal implications. screening allows active interventions which significantly improves pregnancy outcomes. Despite World Health Organization (WHO), FIGO and National Institute of clinical Excellence (NIcE) recommendations for universal screening especially among high risk population; Malaysia currently adopts a selective risk based screening for GDM.
    OBJECTIVE: the objective is to audit the effectiveness of the current practice of selective risk based screening in detection of GDM in Malaysia.
    METHODOLOGY: this is a retrospective cohort study based on the National Obstetric Registry (NOR) which comprises of 14 major tertiary hospitals in Malaysia. the study period was from 1st January 2011 till 31st December 2012 and a total of 22,044 patients with GDM were analysed. Logistic regression analysis was used to calculate the crude odd ratio.
    RESULTS: the incidence of GDM in Malaysia is 8.4%. Maternal age of ≥25, booking bMI ≥27kg/m2, booking weight ≥80kg and previous hypertension are non-significant risk of developing GDM in Malaysia. Parity 5 and more was only associated with an odds-ratio of 1.02 (95% confidence Interval: 0.90-1.17) as compared to parity below 5. the association of women with previous stillbirth with GDM was not significant.
    CONCLUSION: current risk based screening for GDM based on maternal age, booking bMI, weight and hypertension is inappropriate. An ideal screening tool should precede disease complications, which is the novel objective of screening. Universal screening for GDM in Malaysia may be a more accurate measure, especially with regards to reducing maternal and foetal complications.
    MeSH terms: Adult; Humans; Malaysia; Mass Screening; Registries; Retrospective Studies; Cohort Studies; Diabetes, Gestational*
  7. Kuan YC, Nurain MN
    Med J Malaysia, 2017 02;72(1):50-52.
    PMID: 28255140 MyJurnal
    Described herein, a case of Langerhans cell histiocytosis (LCH) in an adult with Idiopathic Thrombocytopenic Purpura (ITP) diagnosed at age ten. She presented with cranial diabetes insipidus, later developed hypogonadotrophic hypogonadism and multiple cervical lympadenopathy from which histopathology of excisional biopsy confirmed LCH. Magnetic resonance imaging showed thickened pituitary stalk. Association of ITP and LCH is unknown but the question of LCH presenting as isolated thrombocytopenia in childhood only to be discovered in adulthood when there was pituitary and bone involvement remains. It reemphasizes the need for high index of suspicion and the challenges in diagnosing LCH at the outset.
    MeSH terms: Adult; Biopsy; Female; Histiocytosis, Langerhans-Cell; Humans; Hypogonadism; Magnetic Resonance Imaging; Pituitary Diseases; Pituitary Gland; Purpura, Thrombocytopenic, Idiopathic; Diabetes Insipidus, Neurogenic
  8. Krishnamoorthy A, Hadi FA, Naidu A, Sathar J
    Med J Malaysia, 2017 02;72(1):53-54.
    PMID: 28255141
    Anaemia is a common condition in Malaysia, and is mostly due to iron deficiency. In many cases, allogeneic blood transfusion (ABT) is administered unnecessarily to treat anaemia. Patient blood management (PBM) is a concept whereby a patient becomes his or her "own blood bank", instead of receiving ABT. The concept encompasses three pillars namely optimising erythropoiesis, minimising blood loss and harnessing human physiological reserve. We present a safe and fruitful outcome of managing severe anaemia without utilising any ABT, made possible with the PBM approach including administration of intravenous iron.
    MeSH terms: Anemia; Blood Banks; Blood Transfusion; Erythropoiesis; Female; Hemorrhage; Humans; Iron; Malaysia; Iron Metabolism Disorders
  9. Lim CH, Benjamin NH, Kan FK
    Med J Malaysia, 2017 02;72(1):55-57.
    PMID: 28255142 MyJurnal
    Upper gastrointestinal haemorrhage (UGIH) in severe dengue represents a clinical dilemma in term of management. The recommended treatment in dengue with UGIH involves blood product transfusion support and proton pump inhibitor (PPI) infusion. Despite being the mainstay of treatment in non-dengue UGIH, the role of endoscopic haemostatic intervention in severe dengue remains controversial. In the present report, we present a case of severe dengue complicated with upper gastrointestinal haemorrhage successfully underwent early therapeutic endoscopic intervention in a district hospital.
    MeSH terms: Blood Transfusion; Dengue; Gastrointestinal Hemorrhage; Hemostatics; Hospitals, District; Severe Dengue; Proton Pump Inhibitors
  10. Peter CA, Anand Swaroop U, Wong BS
    Med J Malaysia, 2017 02;72(1):58-59.
    PMID: 28255143
    Intra-cardiac extension of hepatocellular carcinoma (HCC) is an uncommon but serious condition related to poor prognosis. We report a 57-year-old male diagnosed with HCC with intra-cardiac extension into the right atrium at presentation. There were no symptoms related to cardiac involvement and intra-cardiac extension was incidentally noted on radiological imaging. He was offered palliative treatment and succumbed to his disease within 50 days of first diagnosis.
    MeSH terms: Heart Atria; Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Male; Middle Aged; Palliative Care; Prognosis
  11. Nazli Z, Abdul Fattah AW
    Med J Malaysia, 2017 02;72(1):60-61.
    PMID: 28255144 MyJurnal
    Osteoma is the most common benign tumour of the nose and paranasal sinuses. However, involvement of the sphenoid sinus by osteoma is rare. Most of the time, patients with paranasal sinus osteoma are asymptomatic. However, symptoms may present, depending on the location and extension of the tumour. We report a case of a patient with sphenoethmoidal osteoma found incidentally on imaging, with evidence of impingement onto the optic nerve at the optic canal. However, the patient was asymptomatic. He was surgically treated using the endoscopic transnasal approach.
    MeSH terms: Endoscopy; Humans; Male; Nose; Optic Nerve; Osteoma; Paranasal Sinus Neoplasms; Paranasal Sinuses; Sphenoid Sinus
  12. Jasmine YS, Lee SL, Kan FK
    Med J Malaysia, 2017 02;72(1):62-64.
    PMID: 28255145
    Haemophagocytic lymphohistiocytosis (HLH) is a potentially fatal disorder resulting from uncontrolled hyperinflammatory response. There had been increase in cases of one of the secondary form of HLH, i.e., infectionassociated haemophagocytic syndrome (IAHS) in severe dengue in recent years. However, the condition remains under diagnosed due to lack of awareness compounded by the lack of validated diagnostic criteria. Severe hepatitis with prolonged cytopenias, severe hyperferritinemia, hypofibrinogenemia and persistent fever were evident in all four cases reported. All the subjects survived with supportive care and adjuvant steroid therapy. Prospective controlled studies are needed to develop diagnostic criteria and management protocol for IAHS in severe dengue.
    MeSH terms: Adjuvants, Immunologic; Adjuvants, Pharmaceutic; Hepatitis; Hepatitis A; Prospective Studies; Severe Dengue; Lymphohistiocytosis, Hemophagocytic
  13. Huei TJ, Lip HT, Rahman MS, Sarojah A
    Med J Malaysia, 2017 02;72(1):65-67.
    PMID: 28255146 MyJurnal
    The literature on adrenal gland tumour in HIV-infected patients is scarce. We report a 46-year-old Malay man with HIV and Hepatitis C infection presenting with a large nonfunctioning adrenal tumour. Computed tomography showed a large right adrenal tumour with heterogeneous enhancement and central necrosis. A high index of suspicion of a malignant tumour or pheochromocytoma led us to surgical removal of the adrenal gland. In this case report, we highlight important features to look for during pre-op evaluation of a large adrenal mass. Appropriate action should be taken when there is a suspicion of a pheochromocytoma or malignancy.
    MeSH terms: Adrenal Gland Neoplasms; Adrenal Glands; Hepatitis C; Humans; Malaysia; Male; Pheochromocytoma; Tomography; HIV Infections
  14. Teoh KH, Balraj S, Navarasi SR
    Med J Malaysia, 2017 02;72(1):68-70.
    PMID: 28255147 MyJurnal
    Intrapancreatic accessory spleen (IPAS) is a benign anomaly of splenic embryology and a rare cause of pancreatic pseudotumour. Here, we report a case of a 70-year-old Malay lady whose IPAS was discovered incidentally during her surveillance computed tomography for her underlying left lower lung fibrosis. Radiologically, the lesion mimicked a neuroendocrine pancreatic tumour and was only diagnosed pathologically as IPAS after surgery. In conclusion, recognising IPAS as a differential for enhancing pancreatic mass allows us to exhaust all non-invasive diagnostic means to diagnose this benign lesion. It will allow the patient to avoid unnecessary surgery and its accompanying complications.
    MeSH terms: Female; Humans; Malaysia; Neoplasms; Pancreas; Pulmonary Fibrosis; Splenic Diseases; Tomography, X-Ray Computed; Unnecessary Procedures
  15. Surinder S, George P
    Med J Malaysia, 2017 02;72(1):71-72.
    PMID: 28255148 MyJurnal
    Fracture of hip prostheses is a rare occurrence. A case of bilateral hip prostheses fracture is described here. The need to follow-up and remain vigilant post hip replacement is highlighted.
    MeSH terms: Follow-Up Studies; Hip Prosthesis; Arthroplasty, Replacement, Hip; Fractures, Bone
  16. Chuah KH, Ng CW, Zabri K, Wong CL
    Med J Malaysia, 2017 02;72(1):73-74.
    PMID: 28255149 MyJurnal
    Dengue infection is epidemic but ocular complications of dengue are less reported. We report a case of dengueinfected patient with disturbing ocular symptoms. He was admitted for severe dengue. Subsequently, he presented with symptoms of bilateral central scotoma with metamorphosia. Fundus examination revealed cotton wool spots and flame-shaped haemorrhages at the macula, with dull foveal light reflex. He was diagnosed with bilateral dengue maculopathy. The patient was managed conservatively with surveillance. One week later, his eye symptoms improved and were resolved six months later. Early recognition and close monitoring remains the key to successful management and interventions are rarely needed.
    MeSH terms: Animals; Dengue; Humans; Macula Lutea; Male; Reflex; Retinal Diseases; Scotoma; Severe Dengue
  17. Michael A, Yahya ZO, Mdrazali I, Hanif H
    Med J Malaysia, 2017 02;72(1):75-76.
    PMID: 28255150 MyJurnal
    Penetrating chest wounds is less common but more deadly then blunt trauma. Majority of penetrating chest trauma can be managed conservatively with observation and simple thoracotomy. This case report highlights a bizarre occupational hazard causing a penetrating chest injury and the option of non-invasive management with the aid of computed tomography with 3D reconstruction.
    MeSH terms: Thoracic Injuries; Thoracotomy; Thorax; Tomography; Wounds, Nonpenetrating; Wounds, Penetrating; Imaging, Three-Dimensional
  18. Mohd Said MR, Abdul Rani R, Raja Ali RA, Ngiu CS
    Med J Malaysia, 2017 02;72(1):77-79.
    PMID: 28255151 MyJurnal
    Percutaneous Endoscopic Gastrostomy (PEG) tubes were often offered to patients requiring long term enteral feeding. Even though the procedure is relatively safe, it is associated with various complications such as peritonitis or even death.1 We presented a case of a 54-year-old gentleman with underlying ischemic stroke and pus discharges from a recently inserted PEG tube. Computed Topography (CT) scan confirmed abdominal wall necrotising fasciitis complicated with hyperosmolar hyperglycaemia state (HHS) and later succumbed after 48 hours of admission. Our case illustrated the rare complication related to the insertion of PEG tube; abdominal wall necrotising fasciitis that was associated with mortality.
    MeSH terms: Brain Ischemia; Enteral Nutrition; Gastrostomy; Hospitalization; Humans; Hyperglycemia; Hyperglycemic Hyperosmolar Nonketotic Coma; Intubation, Gastrointestinal; Patient Discharge; Peritonitis; Suppuration; Tomography, X-Ray Computed; Fasciitis, Necrotizing; Stroke; Abdominal Wall
  19. Syazni MA, Gendeh HS, Kosai NR, Ramzisham AR, Gendeh BS, Basiron NH, et al.
    Med J Malaysia, 2017 02;72(1):80-82.
    PMID: 28255152 MyJurnal
    Sternal metastasis from differentiated thyroid carcinoma (DTC) is rare and presents a conundrum for surgeons. We present a lady diagnosed with follicular thyroid carcinoma and sternal metastasis who underwent thyroidectomy, sternectomy and sternoplasty with titanium mesh and acrylic plate. She developed a surgical site infection, of which multiple conservative approaches were attempted. She eventually required removal of the implant. Closure of sternal defect was completed with bilateral pectoralis major advancement flaps. This article highlights a series of complications faced during the course of treatment and how they were managed in a tertiary healthcare centre.
    MeSH terms: Female; Sternum; Surgical Wound Infection; Thyroid Neoplasms; Thyroidectomy; Titanium; Adenocarcinoma, Follicular; Tertiary Healthcare; Surgeons
  20. Chiar CI, Elango T, Sivaneswaran L, Umasangar R, Mohan N
    Med J Malaysia, 2017 02;72(1):83-84.
    PMID: 28255153 MyJurnal
    Alimentary tract duplication is a rare congenital anomaly which may involve any part of the alimentary tract extending from stomach to rectum. Clinical presentation may mimic an inflamed appendix as described in this case. A 9-year-old boy with a clinical diagnosis of perforated appendix was noted to have a normal appendix intra-operatively. On further search for an underlying pathology, a gangrenous ileal duplication was discovered. En-bloc resection with primary bowel anastomosis was done. Histopathology report revealed a gangrenous small bowel duplication. We discuss the preoperative diagnostic dilemma and management options in approaching this rare entity.
    MeSH terms: Appendicitis; Appendix; Child; Digestive System Abnormalities; Humans; Male; Rectum; Stomach
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