Browse publications by year: 2019

Fulltext What can law do to combat obesity in Malaysia?

Sia, Chin Chin, Duraisingam T. J.

Malaysian Journal of Medicine and Health Sciences, 2019;15(102):42-42.
MyJurnal

Introduction: The obesity rate in Malaysia is increasing exponentially. This is alarming as obesity in a population is likely to lead to health complications and negatively impact national economic productivity. The quality of health of our country is of paramount importance to a sustainable nation. To safeguard the health of our population in this country, there are current laws and potential laws to be implemented to combat obesity. In Malaysia, the government have introduced ‘soft policies’ approach such as Healthy life style programmes and campaigns as means to curb obesity yet its impact is questionable. ‘Hard policies’, such as regulations (e.g. imposing a tax, removal of subsidies, reduction of operational hours of eateries, menu-labelling, curbing of marketing of unhealthy food, implementation of pedestrian and bicycle paths, metabo laws) may be used as legitimate interventions to combat obesity in Malaysia. The aims of this paper is to (i) analyse the legal justifications for implementation of obesity prevention regulations, (ii) to compare and contrast the pros and cons of current and potential obesity prevention regulations to reduce obesity. Results and Conclusion: The law could be used to facilitate promotion of public health. In light of new scientific advances, gaps in the current regulatory framework, and the increasingly obesogenic environment, this paper proposes
potential legal approaches to address obesity in Malaysia. It is important for legal scholars to devise innovative strategies to address obesity from new perspectives. The great potential for the law to rectify the status quo has yet to be fully explored. With reduction of obesity, the fiscal burden of the nation on medical bills could be reduced and productivity could be increased.

MeSH terms: Pedestrians; Bicycling; Government; Humans; Malaysia; Obesity; Public Health; Marketing; Healthy Lifestyle
Fulltext Effects of xanthorrhizol on 3T3-L1 adipocyte hyperplasia and hypertrophy [Abstract]

Seok Fang Oon, Meenakshii Nallappan, Mohd Shazrul Fazry Sa’ariwijaya, Nur Kartinee Kassim, Shamarina Shohaimi, Thiam Tsui Tee, et al.

Malaysian Journal of Medicine and Health Sciences, 2019;15(102):41-41.
MyJurnal

ABSTRACTS FOR INTERNATIONAL HEALTH AND MEDICAL SCIENCES CONFERENCE 2019 (IHMSC 2019). Accelerating Innovations in Translational and Precision Medicine. Held at Taylor’s University Lakeside Campus, Subang Jaya, Selangor, Malaysia. 8-9th March, 2019
Introduction: According to the National Health and Morbidity Survey (NHMS) 2015, 47.7% of the Malaysian population are either obese or overweight. The increased obesity prevalence has caused major health problems including cardiovascular diseases and diabetes. Although several anti-obesity drugs have been developed, they are limited due to adverse side effects. Previous studies demonstrated that xanthorrhizol (XNT) reduced the levels of serum free fatty acid and triglyceride in vivo, but the detailed anti-obesity activities and its related mechanisms are yet to be reported. Thus, this study aims to evaluate its abilities to inhibit adipocyte hyperplasia and hypertrophy employing 3T3-L1 adipocytes.
Methods: Statistical significance was established by one-way ANOVA, where p < 0.05 was considered statistically significant.
Results: In this study, the IC50 value of XNT (98.3% purity) from Curcuma xanthorrhiza Roxb. in 3T3-L1 adipocytes was 35 ± 0.24 μg/mL. The loss of cell viability was due to 20.01 ± 2.77% of early apoptosis and 24.13 ± 2.03% of late apoptosis. XNT elicited apoptosis via up-regulation of caspase-3 and cleaved PARP-1 protein expression for 4.09-fold and 3.12-fold, respectively. Moreover, XNT decreased adipocyte differentiation for 36.13 ± 3.64% and reduced GPDH activity to 52.26 ± 4.36%. The underlying mechanism was due to impaired expression of PPARγ to 0.36-fold and FAS to 0.38-fold, respectively. On the other hand, XNT increased glycerol release by 45.37 ± 6.08% compared to control. During lipolysis, XNT up-regulated the leptin protein for 2.08-fold but down-regulated the protein level of insulin to 0.36-fold. These results indicated that XNT reduced the volume of adipocytes through modulation of leptin and insulin.
Conclusion: To conclude, XNT exerted its anti-obesity mechanisms by suppression of adipocyte hyperplasia through induction of apoptosis and inhibition of adipogenesis whilst reduction of adipocyte hypertrophy through stimulation of lipolysis. Thus, XNT could be developed as a potential anti-obesity agent in the future.

MeSH terms: Animals; Cell Survival; Glycerol; Insulin; Lipolysis; Up-Regulation; Prevalence; Anti-Obesity Agents; Leptin; Curcuma; PPAR gamma; Adipogenesis; Mice; Caspase 3; Poly (ADP-Ribose) Polymerase-1
Fulltext Overweight and obesity among employees at a private university in Malaysia: a cross-sectional study towards a healthy workplace

Jo Ann Andoy-Galvan, Nimesha Tillekeratne, Tilanka Tillekeratne

Malaysian Journal of Medicine and Health Sciences, 2019;15(102):40-40.
MyJurnal

Introduction: Obesity is a growing public health concern. Poor diet and lifestyle choices are the main contributors to its development. Lifestyle modifications should be aggressively promoted in the community. Recent studies found that worksite obesity prevention and control programs are effective in increasing physical activity and weight reduction among employees. In Malaysia, there is insufficient data on prevalence studies of workplaces. This study investigated the proportion of overweight and obesity among workers in a private university and hope to serve as a baseline for future healthy workplace programs. Methods: This cross-sectional study investigated overweight and obesity and examined its association with occupational stress, sleeping quality, dietary behaviour and physical inactivity among employees in an academic institution. Weight and height were measured, and BMI was calculated and coded as underweight, normal, overweight and obese according to the cut-off points for the Asian population. Results: Out of ninety-five employees, 55 participated in the survey. Among the 55 employees, 4 (7.3%) were underweight, 10 (18.2%) were normal, 25 (45.5%) were overweight, and 16 (29.1%) were obese. The obese and overweight proportion was similar to the national prevalence. Poor sleep quality and high Job stress scores were reported by 40% of the employees, while physical inactivity of more than 6 hours a day was reported by 50%, and the majority (90%) do not consume enough fibre. Among the risk factors investigated, none was associated with obesity. Conclusion: The proportion of overweight and obesity in this community was like the general population. While not significant in this study, the association between obesity and the four risk factors should be further investigated using a larger sample size. Based on the results, community-based health promotion intervention is suggested to reduce obesity among the employees.

MeSH terms: Body Weight; Cross-Sectional Studies; Humans; Malaysia; Obesity; Public Health; Risk Factors; Thinness; Universities; Weight Loss; Body Mass Index; Prevalence; Workplace; Sample Size; Overweight
Fulltext Rodent model of obesity mimicking human metabolic syndrome

Aamir K., Khan H., Arya A.

Malaysian Journal of Medicine and Health Sciences, 2019;15(102):39-39.
MyJurnal

Introduction: Polymetabolic syndrome is a malady encompassing centralized accumulation of lipids and subsequent resistance to insulin leading towards diabesity. Currently, this condition is perilous threat to public health and also, creating perplexity for medical scientists. There is an intensive need for the development of obese rodent model having close resemblance with human metabolic syndrome (MetS); so that intricate molecular and/or therapeutic
targets can be elucidated. The resultant simulations will be beneficial to explicate not only pathogenesis but also secret conversation of signaling pathways in inducing MetS related complications in other organs. Methods: Currently, there are different methods for the development of rodent models of MetS, for instance, utilizing high lipogenic diet, genetic alterations, induction by chemicals or by combination of high fat diet and few others. In general, combination of cafeteria or western diet and low dose of streptozotocin (STZ) is a fine example of diet induced experimental model. In this model animals are allowed free access to highly palatable, energy dense, unhealthy human food for 12-18 weeks which promotes voluntary hyperphagia resulting in weight gain, increased fat mass and insulin resistance. At the end of feeding period 30mg/kg STZ is given intraperitoneally to mimic human type 2 diabetic condition.
Conclusion: Consumption of cafeteria diet with low dose STZ is considered to be the robust model of diabesity offering an exceptional stage to investigate the genomic, molecular, biochemical and cellular mechanisms of obesity and type 2 diabetes.

MeSH terms: Animals; Diabetes Mellitus, Type 2; Humans; Hyperphagia; Insulin; Insulin Resistance; Lipids; Models, Theoretical; Obesity; Public Health; Rodentia; Streptozocin; Weight Gain; Diet, High-Fat; Insulin, Regular, Human; Diet, Western
Fulltext The use of biologics in children with allergic rhinitis and chronic rhinosinusitis: Current updates

Shinee T, Sutikno B, Abdullah B

Pediatr Investig, 2019 Sep;3(3):165-172.
PMID: 32851312 DOI: 10.1002/ped4.12146

The therapeutic goals of the treatment of allergic rhinitis (AR) and chronic rhinosinusitis (CRS) are symptom relief, avoiding complications, and improving quality of life. In the treatment of AR and CRS, several limitations of currently prescribed medicines have been identified. Antihistamine administration (both oral and topical) together with intranasal corticosteroids bring relief to the majority of patients, but their dependency on the medications and a necessity to maintain strict compliance with regular medication regimes pose a challenge. Immunotherapeutic agents are an option in some patients, but polysensitized patients, the risk of anaphylaxis, and the need for daily administration for years are limiting it from becoming the main therapy modality. Immunotherapy in any form requires commitment by the patient, which renders adherence and compliance issues particularly relevant. The procedure involved are generally time-consuming and entail an associated risk of severe adverse reactions. The use of biologics could overcome the limitations of other therapeutic modalities. They could be used as a monotherapy or combined with pre-existing medications. The benefits of targeted therapy include less adverse effects and optimal efficacy. The aim of the present review was to investigate the collective literature to date pertaining to the role of biologics in managing children with AR and CRS.
Fulltext Multidisciplinary approach to children with sinonasal tumors: A review

Lazim NM, Abdullah B

Pediatr Investig, 2019 Sep;3(3):173-179.
PMID: 32851313 DOI: 10.1002/ped4.12147

Sinonasal tumors in children are rare and difficult to manage. These tumors can be broadly categorized into congenital or acquired and benign or malignant. The tumors mainly arise from the mucosa, cartilage, or bone of the nasal cavity and may occupy areas of the nasal septum, turbinates, osteomeatal complex, sinuses, and nasopharynx. The management of pediatric sinonasal tumors is challenging, especially in cases of malignancy. Malignant tumors pose a treatment dilemma because most such tumors tend to be aggressive and carry a poor prognosis. Multiple complications associated with the primary disease or treatment may occur, and such complications need to be fully addressed to provide optimal care. In most cases, a multidisciplinary team approach will offer the best possible outcome for children with sinonasal tumors.
Fulltext Quality of life in children following nasal septal surgery: A review of its outcome

Saniasiaya J, Abdullah B

Pediatr Investig, 2019 Sep;3(3):180-184.
PMID: 32851314 DOI: 10.1002/ped4.12145

Nasal septal surgery among children remains controversial because of its adverse effect on craniofacial development. Recent studies, however, have demonstrated that early nasal septal correction prevents the midfacial and nasal growth deformity that is the inevitable consequence of nasal septal abnormality. Nasal septal surgery in children has been reported to lead to significant improvement in quality of life. We reviewed the existing literature to evaluate the outcomes of pediatric nasal septal surgery.
Fulltext Foreign body ingestion in an infant: A high index of suspicion is required

Mohamad Ishak LA, Khor KG, Tan SN

Pediatr Investig, 2019 Sep;3(3):188-190.
PMID: 32851316 DOI: 10.1002/ped4.12149

INTRODUCTION: The incidence of foreign body ingestion in the upper gastrointestinal tract accounts for 75%-85% of foreign body ingestions in pediatric patients.
CASE PRESENTATION: An 8-month old boy presented with vomiting and was referred to the otorhinolaryngology team based on his mother's suspicion that her child might have ingested a foreign body. Flexible laryngoscopy revealed a phone screen protector at the vallecular region. The foreign body was removed in the operating theatre.
CONCLUSION: Foreign body ingestion should always be suspected in young patients. Consideration of the patient's symptoms, level of lodgement, and type of foreign body will determine whether immediate intervention or a conservative approach is warranted.
Fulltext Isolated congenital tracheal stenosis: A rare and deadly condition

Arunathan R, Ariffin AHZ, Khor KG, Tan SN

Pediatr Investig, 2019 Sep;3(3):191-193.
PMID: 32851317 DOI: 10.1002/ped4.12148

INTRODUCTION: Congenital tracheal stenosis (CTS) is a serious and rare condition. In most cases, CTS is associated with cardiopulmonary abnormalities; however, isolated CTS is present in 10%-30% of patients. The severity of the disorder is dependent on the symptoms, which correlate with the CTS classification.
CASE PRESENTATION: We discuss our findings in an infant who presented with severe respiratory compromise where incidental intra-operative findings revealed CTS with no cardiopulmonary abnormalities. Because of a lack of resources in the emergency department, we created a tracheostoma and inserted an endotracheal tube.
CONCLUSION: The main aim in treating CTS is to secure the airway and provide sufficient oxygen.
Glial Heterotopia of the Base of Tongue: A Case Report

Tuang GJ, Lee JPH, Velayutham P, Git KA, Ariffin NAA, Abidin ZAZ

Medeni Med J, 2019;34(3):324-328.
PMID: 32821456 DOI: 10.5222/MMJ.2019.88886

Glial heterotopia of oropharynx is a congenital anomaly, whereby ectopic mature glial tissue is found around oropharynx isolated from the brain and spinal cord. Herein we report a rare presentation of a mass at the base of tongue in a neonate. In addition, to underscore the rarity of oropharygeal glial heterotopia, we discuss the dilemma in approaching its diagnosis and management in a neonate.

MeSH terms: Brain; Humans; Infant, Newborn; Nervous System Malformations; Oropharynx; Spinal Cord; Tongue Diseases
Significance of Nasal Septum Angulation and Its Association with Rhinosinusitis Symptom Scores

Lazim NM, Abdullah AM, Abdullah B, Ismail ZIM

Medeni Med J, 2019;34(4):333-339.
PMID: 32821458 DOI: 10.5222/MMJ.2019.25986

Objective: The aim of the study was to determine the association of angulation of nasal septum with the severity of rhinosinusitis as measured by symptom score and Visual Analog Score (VAS).
Method: The study was performed as a cross sectional study conducted at two different centres in Malaysia. Ninety-eight patients who were diagnosed with rhinosinusitis and fulfilled the selection criteria were assessed as for the symptom score and VAS and the measurement of angulation of nasal septum was performed through a coronal view of CT paranasal sinuses in bone window setting at osteomeatal complex level.
Results: The result obtained from one-way ANOVA test revealed a significant association between category of severity of septal angulation and the symptom score of rhinosinusitis (p=0.025). In addition, the result obtained from one-way ANOVA test also revealed a significant association between category of severity of septal angulation and the VAS of rhinosinusitis (p<0.05).
Conclusion: Severity of nasal septum angulation may be significantly associated with severity of rhinosinusitis based on symptom score and VAS. These findings could be used in tailored management of patient with rhinosinusitis especially during functional endoscopic sinus surgery.

MeSH terms: Analysis of Variance; Cross-Sectional Studies; Humans; Malaysia; Nasal Septum; Paranasal Sinuses; Sinusitis; Tomography, X-Ray Computed; Patient Selection
Shiftwork Association with Cardiovascular Diseases and Cancers Among Healthcare Workers: A Literature Review

Yau A, Haque M

Medeni Med J, 2019;34(4):387-395.
PMID: 32821466 DOI: 10.5222/MMJ.2019.54775

The round-the-clock demands of healthcare services, coupled with the shortage of healthcare providers in many parts of the world, have made shiftwork widespread among healthcare workers. Understanding how to mitigate unfavourable effects of shiftwork on well-being is essential to improve health promotion, to prevent disease prevention, and to increase quality of life. This comprehensive review aims to present evidence linking shiftwork with cardiovascular diseases and cancers among healthcare workers. Several studies have demonstrated evidence indicating the relationship between long-term exposure to shiftwork tempo and a higher risk of cardiovascular diseases. Health workers are increasingly witnesing unfavourable effects of shiftwork on their health state. Shiftwork disturbs circadian rhythm and cardiopulmonary processes, leading to adverse health outcomes. Increasing prevalence of shiftwork in healthcare industries due to population expansion and public health threat of cancers call for investigation towards a better understanding of the underlying mechanism of shiftwork-induced diseases. The shift work period has been considered in different studies using various criteria, resulting in inconsistent definition of measurement criteria leading to misclassification of the study population. There is a need for a more considerable and holistic effort towards standardization of shiftwork definition and conduct an assessment to establish a more conveniently appliacable framework for intervention strategies.

MeSH terms: Cardiovascular Diseases; Circadian Rhythm; Health Personnel; Health Promotion; Humans; Neoplasms; Public Health; Quality of Life; Prevalence; Health Care Sector
Aspiration Avoiding Tracheostomy in Neonatal Cystic Oral Lesion

Nasir MSNM, Ishak MN, Abd Wahid FH, Asif JA, Mohamad I

Medeni Med J, 2019;34(4):400-403.
PMID: 32821468 DOI: 10.5222/MMJ.2019.44977

Oral cyst is uncommon in the neonatal period. Depending on the size and site of occurrence, its symptoms may vary. If not diagnosed and managed expeditiously, these oral cysts may cause significant and potentially fatal morbidity and mortality. We report a successfully managed case of oral cyst in neonate that presented with huge tongue at birth and complaints of impending airway obstruction. She was referred for tracheostomy as intubation was impossible. We attempted needle aspiration and the airway successfully relieved without the need for tracheostomy.

MeSH terms: Airway Obstruction; Cysts; Female; Humans; Infant, Newborn; Intubation, Intratracheal; Tongue; Tongue Diseases; Tracheostomy
Fulltext Strongyloides Hyperinfection Syndrome in an Immunosuppressed Patient

Cheo, Seng Wee, Tan, Yee Ann, Low, Qin Jian

Borneo Journal of Medical Sciences, 2019;13(1):39-43.
MyJurnal

Strongyloides stercoralis is an intestinal nematode which is endemic in tropical and subtropical countries. The global prevalence of Strongyloides is unknown. Strongyloidiasis is found more frequently in the socioeconomically disadvantaged, in institutionalized populations, and in rural areas. The spectrum of disease varies. It may cause asymptomatic infection, mild eosinophilia or hyperinfection syndrome in the most severe form. Here we reported a case of Strongyloides hyperinfection syndrome in an immunosuppressed patient. This patient is a 54-year-old man with myasthenia gravis on long term azathioprine and prednisolone. He presented with fever associated with diarrhoea and was in septic shock. His blood culture was positive forKlebsiella pneumoniae.Strongyloides stercoralis larvae were detected in his sputum and stool sample. He was diagnosed to have Strongyloides hyperinfection and was treated with subcutaneous ivermectin. He recovered well. Our case demonstrated the association of Strongyloideshyperinfection with superimposed gram-negative sepsis as a consequence of prolonged immunosuppression. A high index of suspicion is needed in approaching patient with risk factors of hyperinfection syndrome.

MeSH terms: Animals; Azathioprine; Diarrhea; Fever; Humans; Immunosuppression; Ivermectin; Male; Middle Aged; Prednisolone; Risk Factors; Shock, Septic; Sputum; Strongyloidiasis; Prevalence; Immunocompromised Host; Strongyloides stercoralis; Asymptomatic Infections; Blood Culture
Fulltext Non-Cirrhotic Portal Hypertension: A Case of Bleeding Gastro-Oesophageal Varices with Non-Cirrhotic Liver Reported in East Malaysia

Payus, Alvin Oliver, Leow, Justin Wen Hsiang, Liew, Sat Lin, Malehah Mohd Noh

Borneo Journal of Medical Sciences, 2019;13(1):33-37.
MyJurnal

Non-cirrhotic portal hypertension (NCPH) is clinically defined as the presence of portal hypertension in the background of non cirrhotic liver. It is diagnosed by the findings in ultrasound of the hepatobiliary system and also oesophagogastroduodenoscopy (OGDS) that consistent with that of a portal hypertension, but otherwise has a relatively normal liver function and echotexture. The treatment mainly focuses on primary and secondary prophylaxis of variceal bleeding both pharmacologically like non-selective beta-blockers and octreotide, and non-pharmacologically like endoscopic band ligation of varices and sclerotherapy. In advance cases, sometimes surgery such as Porto systemic shunt or splenectomy may be required especially in patients with uncontrolled variceal bleeding or with symptomatic hypersplenism. Here we report a case of a young man who presented with upper gastro-intestinal bleeding, which was initially thought from a bleeding ulcer but was found to be secondary to oesophageal and gastro-oesophageal varices. Apart from having mild ascites, he has no other features of portal hypertension. His liver biochemistry and echotexture were also normal. Unfortunately, the patient was lost to follow up while he was still in the early stage of investigating the condition. The purpose of this case report is to share an uncommon occurrence of NCPH in East Malaysia, where liver cirrhosis predominates the aetiology of portal hypertension. Also, to the best of our knowledge, there is a very limited reporting of a similar case in this region.

MeSH terms: Ascites; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Hypersplenism; Hypertension, Portal; Ligation; Liver Cirrhosis; Malaysia; Male; Splenectomy; Ulcer; Varicose Veins; Octreotide; Sclerotherapy; Endoscopy, Digestive System; Lost to Follow-Up
Fulltext Isolated Hypophosphataemia Mimicking Cerebrovascular Accident

Hanizah Ngadiron, Razrim Rahim, Firdaus Hayati, Nornazirah Azizan, Affirul Chairil Ariffin

Borneo Journal of Medical Sciences, 2019;13(1):29-32.
MyJurnal

Hypophosphataemia occurs in an abnormally low serum phosphate level. Three main mechanisms are postulated: decreased intestinal absorption, increased renal excretion, and extracellular shifts to intracellular compartments. It is potentially a fatal disease if not intervene. The management is merely treating the underlying disorder, giving phosphate supplement and requiring close biochemical monitoring. The incidence of symptomatic isolated hypophosphataemia is extremely rare. In this case report, a 33-year-old man presented with three days history of dysphagia, inability to complete sentences and generalized muscle weakness. He developed blurred vision especially upon exposure to bright light. He had a history of single parathyroidectomy for parathyroid adenoma 2 years ago. Physical examinations were unremarkable. Laboratory investigations were normal except for phosphate level of 0.30 mmol/L. Intravenous KH2PO4 with a dosage of 10 mmol was administered in slow bolus in 3 hours. His symptoms resolved slowly after correction. Although isolated hypophosphataemia is rare but need to recognize the symptoms and signs of hypophosphataemia and treat accordingly.

MeSH terms: Adult; Deglutition Disorders; Humans; Intestinal Absorption; Male; Parathyroid Neoplasms; Phosphates; Phosphorus Metabolism Disorders; Physical Examination; Incidence; Parathyroidectomy; Hypophosphatemia; Muscle Weakness; Renal Elimination
Fulltext Metastatic Squamous Cell Carcinoma of Sternum: An Oncological Curiosity

Jia, Ying Soo, Nur Ayub Mohd Ali, Aishath Azna Ali, Firdaus Hayati, Nornazirah Azizan, Andee Dzulkarnaen Zakaria, et al.

Borneo Journal of Medical Sciences, 2019;13(1):23-27.
MyJurnal

Skeletal metastasis is a frequent complication of cancer resulting in significant morbidity as well as mortality. We highlight a case of a 73-year old gentleman with metastatic squamous cell carcinoma of the sternum. He denied dysphagia, shortness of breath, goitre, and presence of chronic non-healing ulcer. He was anaemic and carcinoembryonic antigen (CEA) was 18.7. Chest radiograph on lateral view showed a suspicious cortical irregularity. Computed tomography (CT) scan of thorax revealed an aggressive sternal lesion with soft tissue component. Ultrasound guided biopsy was performed and the biopsy was consistent with metastatic squamous cell carcinoma. Squamous cell carcinoma has a predilection to metastasize via haematogenous spread, but direct extension of tumour into the bone is not frequently seen. Finding the primary cause is utmost importance either via imaging modalities or invasive procedures. Isolated secondary lesion is extremely rare but unfortunate among defaulters. We discuss its diagnostic work-up and treatment options conserved to manage this condition.

MeSH terms: Aged; Biopsy; Carcinoembryonic Antigen; Carcinoma, Squamous Cell; Deglutition Disorders; Dyspnea; Goiter; Humans; Male; Neoplastic Processes; Sternum; Tomography, X-Ray Computed; Ulcer; Ultrasonography, Interventional; GPI-Linked Proteins
Fulltext Recent Advances in Breast Cancer Diagnosis Entering an Era of Precision Medicine

Lim, Christopher, Mra, Aung, Chin, Suliong, Venkata Rao, Challa, Aung, Tun, Sieman, Jony, et al.

Borneo Journal of Medical Sciences, 2019;13(1):3-9.
MyJurnal

This article will cover some of the most recent advances in the diagnosis of the world’s most common cancer in women, namely, breast cancer as we enter the era of precision medicine. The authors will discuss the differences between East and West pertaining to the incidence and mortality rates, the types of breast cancer and the revised staging criteria of breast cancer according to the American Joint Committee on Cancer (AJCC) Staging Manual, 8th edition. In addition, the advances of newer imaging modalities are presented and compared with traditional ultrasonography and mammography

MeSH terms: Female; Humans; Mammography; Neoplasm Staging; Neoplasms; Ultrasonography; United States; Incidence; Precision Medicine
Fulltext Case Series of Pancytopenia Secondary to Pernicious Anaemia

Low, Qin Jian, Hong, Eric Qiu Weng, Cheo Seng Wee

Borneo Journal of Medical Sciences, 2019;13(2):55-59.
MyJurnal

Pernicious anaemia is an autoimmune disorder where vitamin B12 deficiency is caused by autoantibodies that interfere with vitamin B12 absorption by targeting intrinsic factor or parietal cells or both. It is commonly associated with anaemia, rarely pancytopenia. Here we reported two cases of pancytopenia due to undiagnosed pernicious anaemia. First case was a 26-year-old man presented with lethargy and reduced effort tolerance, associated with postural giddiness and palpitation. Clinically, he was pale with no other findings. On blood investigations, the patient was diagnosed pancytopenia secondary to pernicious anaemia. He was treated with daily subcutaneous injection of vitamin B12 cyanocobalamin 1 mg for one week followed by weekly injection for a month and subsequently with lifelong monthly subcutaneous injection. After receiving 2 weeks of B12 replacement, his full blood count had normalized and his symptoms resolved. Second case was a 65-year-old man presented with yellowish discolouration of the eyes with lethargy. On examination, he was pale with jaundice. On blood investigations, the patient was diagnosed pancytopenia secondary to pernicious anaemia. He was started with intramuscular injection of 1000 mcg vitamin B12 replacement daily for one week followed by monthly for 6 months. After one week of B12 replacement, his full blood count had normalized. He was started on lifelong 3 monthly injections of vitamin B12 replacement and he remained symptom free. Patients with pernicious anaemia often present with general signs and symptoms which occur insidiously. It is important that early diagnosis is made to avoid harmful complications such as neuropsychiatric disorders.

MeSH terms: Adult; Aged; Anemia; Anemia, Pernicious; Autoantibodies; Autoimmune Diseases; Humans; Injections, Intramuscular; Injections, Subcutaneous; Intrinsic Factor; Jaundice; Male; Pallor; Pancytopenia; Parietal Cells, Gastric; Vitamin B 12; Vitamin B 12 Deficiency; Early Diagnosis; Lethargy
Fulltext Diagnosis and Management of Ovarian Cancer: Current Status and Future Potential

Pei, Yin Kang, Ho, Shuyan

Borneo Journal of Medical Sciences, 2019;13(2):49-54.
MyJurnal

Ovarian carcinoma is the fifth common cause of cancer death among women in Malaysia, with five-year survival rates of 30%. It has been associated with delayed diagnosis, advanced stage of presentation and poor prognosis due to vague symptoms and lack of effective screening. The continued high fatality rate has underpinned efforts to develop effective screening tests and newer therapies that could impact on prognosis. New insights into proteomic analysis and genomic tests with a better understanding of the target lesion have leading to discovery of new treatment modalities in ovarian carcinoma. We present a 58-year-old lady with Stage IV ovarian cancer who had lower abdominal pain and mass, constipation and voiding frequency for six months duration. Ultrasound guided biopsy revealed serous adenocarcinoma likely ovarian in origin. CT scan showed gross ascites and right ovarian mass with infiltration to adjacent small bowel. Tumour markers CA 125 and LDH were high. She has received neoadjuvant chemotherapy followed by cytoreductive surgery and currently in remission.

MeSH terms: Ascites; Female; Humans; Malaysia; Middle Aged; Ovarian Neoplasms; Prognosis; Tomography, X-Ray Computed; Biomarkers, Tumor; Abdominal Pain; Survival Rate; Cystadenocarcinoma, Serous; Neoadjuvant Therapy; Proteomics; Early Detection of Cancer; Delayed Diagnosis; Cytoreduction Surgical Procedures

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