Browse publications by year: 2020

  1. Chong DWQ, Iqbal AR, Kaur Jaj B, Zainab A, Nordin A, Abd Majid ND, et al.
    Med J Malaysia, 2020 11;75(6):691-697.
    PMID: 33219179
    INTRODUCTION: The quality of information and efficiency in the practice and care environments are important aspects of nursing care. The use of a reliable and valid scale can monitor the quality of handover and provide information for continuous improvement of practice. This study aims to describe the perception of nurses, on the domains of quality of information, efficiency, interaction and support and patient involvement.

    METHOD: A cross-sectional descriptive study was conducted among 450 nurses from 37 wards in Hospital Kuala Lumpur. Nurses on shift duty were recruited by convenience sampling from the Medical, Surgery, Obstetrics & Gynaecology, Orthopaedic and Paediatric wards. Using a validated questionnaire (Handover Evaluation Scale), nurses self-rated their perceptions using a 7-point scale and provided open-ended responses to the strengths and challenges that they faced. Descriptive and inferential analyses were done while open-ended questions were summarised based on key themes.

    RESULTS: A total of 414 nurses completed the survey (92.0% response rate). Nurses had an overall mean (SD) perception score of 5.01 (SD 0.56). They perceived good interaction and support during handover and on the quality of information that they received, with mean scores of 5.54 (SD 0.79) and 5.19 (SD 0.69), respectively. There was an association between the departments where the nurses worked and their overall perceptions on nursing handover (p<0.001). Interruptions being the most common theme emerged from the open-ended section.

    CONCLUSION: Despite having substantial interaction and support amongst nurses, opportunities for improvements were noted. Improvements in the quality of handover information and reducing interruptions should be the main emphases as these were perceived to be essential in the current handover practices by nurses.

    MeSH terms: Medical-Surgical Nursing; Child; Cross-Sectional Studies; Female; Gynecology; Hospitals; Humans; Longitudinal Studies; Orthopedics; Patient Participation; Pregnancy; Surveys and Questionnaires; Obstetric Surgical Procedures; Patient Handoff
  2. Makhmudi A, Wirohadidjojo YW, Gahara E, Noor HZ, Sunardi M, Mahmudah NA, et al.
    Med J Malaysia, 2020 11;75(6):698-704.
    PMID: 33219180
    INTRODUCTION: Several studies have reported the disturbance in the process of wound healing after administration of mitomycin-C, which inhibits granulation tissue formation and collagen synthesis, resulting in chronic wounds. The vitreous gel of cow eyeballs contains a high level of hyaluronic acid, which has a role in inflammation, granulation, re-epithelialization, and remodelling. This study aims to understand the effect of 1% povidone iodine and vitreous gel of cow eyeballs on wound healing after administration of mitomycin-C.

    METHODS: This was an in vivo study with quasi-experimental methods on 32 Wistar mice. Full-thickness wounds were made and then treated with mitomicyn-C. The mice were divided into 4 groups: a control group with NaCl 0.9% vitreous gel of cow eyeball (VGCE), 1% povidone-iodine, and a combination of VGCE and 1% povidone-iodine groups. Macroscopic and microscopic observations of the process of wound healing were performed on days 3, 7, and 14.

    RESULTS: Vitreous gel administration produced significant wound healing rates within the first three days, and histological analysis revealed an increased number of fibroblasts and polymorphonuclear cells. However, the povidone iodine group and the combination group with vitreous gel did not produce significant results.

    CONCLUSION: The single administration of VGCE can accelerate the wound healing process, increase the number of fibroblasts, and reduce inflammation in a chronic wound model.

    MeSH terms: Animals; Cattle; Collagen; Female; Fibroblasts; Granulation Tissue; Hyaluronic Acid; Inflammation; Povidone-Iodine; Sodium Chloride; Vitreous Body; Wound Healing; Mitomycin; Control Groups; Mice; Re-Epithelialization
  3. Othman AK, Udin N, Shab MS, Hamzah NA, Mat Azmi IS, Naing NN
    Med J Malaysia, 2020 11;75(6):705-709.
    PMID: 33219181
    INTRODUCTION: Brain tumour (BT) is a tremendous burden on patients, families as well as the surrounding communities, especially the healthcare services. It can be classified into either a benign slow growing tumour (non-cancerous) and malignant tumour (cancerous). The purpose of this study was to determine the incidence and pattern of brain tumour admitted to the Neurosurgery Department in Hospital Sultanah Nurzahirah (HSNZ), Terengganu, Malaysia.

    METHODS: This is a retrospective study of incidence and pattern of BT admitted to the Neurosurgery Department in HSNZ. Data was collected from the yearly census of BT registered from 2013 to 2018.

    RESULTS: A total number of 386 new cases of primary BT were registered. The number of cases of BT was found to be lowest among children (0 to 10 years old) with only 4.4% but at peak among elderly aged between 51 to 60 years old (26.2%). As for gender, males constituted about 44.5% (n=172) whereas females accounted for 55.5% (n= 214) of the cases. In total, meningioma was found to have the highest incidence (27.2%) followed by metastases brain tumour (18.1%) and glioma (17.4%).

    CONCLUSIONS: This study has shown that the incidence of BT was led by meningioma which had a high prevalence among the elderly population, followed by metastasis BT and gliomas.

    MeSH terms: Aged; Brain Neoplasms; Child; Child, Preschool; Female; Glioma; Humans; Infant; Infant, Newborn; Malaysia; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neurosurgery; Retrospective Studies; Incidence; Prevalence; Censuses; Neurosurgical Procedures
  4. Perveen RA, Nasir M, Talha KA, Selina F, Islam MA
    Med J Malaysia, 2020 11;75(6):710-716.
    PMID: 33219182
    INTRODUCTION: Currently, there are several attempts to find an effective antiviral drugs against the COVID-19. Although majority of the COVID-19 patients have mild to moderate clinical events, up to 5-10% may have severe, life threatening events that urgently require effective drugs. The purpose of this systematic review is to evaluate the effectiveness of antiviral therapies in the treatment of COVID-19.

    METHODS: An extensive search was performed in PubMed, EMBASE, Cochrane Library for randomised controlled trials (RCTs), prospective case series studies that evaluated therapies COVID-19. The outcomes searched for were mortality, recovery rate, length of hospital stay and clinical improvement from January to May 15, 2020. Independent reviewers searched, identified, screened, and related studies were included.

    RESULTS: Total of five RCTs on 439 patients and seventeen case series involving 1656 patients were found in the specified review period that reported the use of Lopinavir, Ritonavir, Remdesivir. Oseltamivir, Ribavirin in patients with COVID-19; but none of which showed efficacy of antiviral therapy. Such current findings impede researchers from recommending an appropriate and effective antiviral therapy against COVID-19, making it a serious concern for the global community.

    DISCUSSION: In the present pandemic and any future epidemics, all the related authorities should pursue many more RCTs, cohort and case series for a prospective outcome in the management and treatment guidelines.

    MeSH terms: Antiviral Agents/therapeutic use; Humans; Ribavirin/therapeutic use*; Pandemics*
  5. Marzuki NM, Jaeb MZM, Ban A, Ismail AI, Ali IAH, Razali NM, et al.
    Med J Malaysia, 2020 11;75(6):717-721.
    PMID: 33219183
    BACKGROUND: Regarding the long-term safety issues with the use of inhaled corticosteroids (ICS) and the clinical predominance of dual bronchodilators in enhancing treatment outcomes in chronic obstructive pulmonary disease (COPD), ICS is no longer a "preferred therapy" according to the Global Initiative for Chronic Obstructive Lung Disease except on top of a dual bronchodilator. This has necessitated a change in the current therapy for many COPD patients.

    OBJECTIVE: To determine a standardised algorithm to reassess and personalise the treatment COPD patients based on the available evidence.

    METHODS: A consensus statement was agreed upon by a panel of pulmonologists in from 11 institutes in Malaysia whose members formed this consensus group.

    RESULTS: According to the consensus, which was unanimously adopted, all COPD patients who are currently receiving an ICS-based treatment should be reassessed based on the presence of co-existence of asthma or high eosinophil counts and frequency of moderate or severe exacerbations in the previous 12 months. When that the patients meet any of the aforementioned criteria, then the patient can continue taking ICS-based therapy. However, if the patients do not meet the criteria, then the treatment of patients need to be personalised based on whether the patient is currently receiving long-acting beta-agonists (LABA)/ICS or triple therapy.

    CONCLUSION: A flowchart of the consensus providing a guidance to Malaysian clinicians was elucidated based on evidences and international guidelines that identifies the right patients who should receive inhaled corticosteroids and enable to switch non ICS based therapies in patients less likely to benefit from such treatments.

    MeSH terms: Adrenal Cortex Hormones; Algorithms; Asthma; Bronchodilator Agents; Eosinophilia; Eosinophils; Humans; Malaysia; Software Design; Treatment Outcome; Pulmonary Disease, Chronic Obstructive; Consensus; Pulmonologists
  6. Khoo PLZ, Poon JS, Tan GJS, Yahya A, Chan KMJ
    Med J Malaysia, 2020 11;75(6):722-730.
    PMID: 33219184
    INTRODUCTION: Heart valve disease comprises a cluster of conditions affecting the aortic, mitral, pulmonary and tricuspid valves. This paper reviews all the research on heart valve disease in Malaysia published between the years 2000- 2016.

    METHODS: The methodology was based on the search process described in the paper, "Bibliography of clinical research in Malaysia: methods and brief results". The search databases included PubMed, Scopus and several Malaysian journals such as MyJurnal and UKM Journal Repository, by using the following keywords: (heart valve disease OR infective endocarditis OR rheumatic heart disease) and (Malaysia).

    RESULTS: In all 94 papers were identified of which 39 papers were selected and reviewed on the basis of their relevance. The local studies contributed to the knowledge and understanding of the epidemiology, aetiology, pathophysiology, clinical presentations, investigations, treatment, and outcomes of heart valve disease in the country.

    DISCUSSION: The clinical relevance of the studies performed in the country is discussed along with recommendations for future research.

    MeSH terms: Endocarditis; Endocarditis, Bacterial; Heart Valve Diseases; Malaysia; Periodicals as Topic; Rheumatic Heart Disease; Tricuspid Valve; Bibliometrics; PubMed
  7. Lwin S, San Yi M, Mardiana K, Woon SY, Nwe TM
    Med J Malaysia, 2020 11;75(6):731-733.
    PMID: 33219185
    The association of ovarian teratoma and anti-N-Methyl-Daspartate receptor (anti-NMDAR) is one of the most common autoimmune encephalitis syndromes and it is a serious and potentially fatal pathology that occurs in young women. This case report describes of a pediatric patient with anti-NMDAR encephalitis. A-12-year-old girl presented with abnormal behavior for one week came to Emergency Department of Sarawak General Hospital, Malaysia. She had psychotic spectrum symptoms including suicidal tendency. She was diagnosed with anti-NMDAR encephalitis as positive antibody was seen in her cerebrospinal fluid. She was treated with Injection Immunoglobulin. She turned out to have teratoma which was successfully removed later. Her progress was remarkable after the surgery with the Immunoglobulin. A multi-disciplinary team involving a psychiatrist, neurologist and gynaecologist liaised with intensivist to successfully manage the case and achieve the good outcome.
    MeSH terms: Child; Emergency Service, Hospital; Female; Hospitals, General; Humans; Immunoglobulins; Malaysia; Ovarian Neoplasms; Psychiatry; Syndrome; Teratoma; Hashimoto Disease; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Neurologists
  8. Tan ST, Yoong BK
    Med J Malaysia, 2020 11;75(6):734-735.
    PMID: 33219186
    Tacrolimus, which bonds to an immunophilin, FK506 binding protein (FKBP) has emerged as one of the most widely used immunosuppressant post solid organ transplantation. It offers excellent patient survival rates post-transplantation and a lesser number of acute rejections as compared to cyclosporine. Tacrolimus has a narrow therapeutic window with overexposure leading to acute and chronic forms of nephrotoxicity. Remarkably few data have been published on the overexposure to tacrolimus following mild diarrhoea in post-transplant patients who received treatment with tacrolimus. We observed a post-liver transplant patient with increased trough level of tacrolimus during severe diarrhoea with no complications following a timely adjustment on the dose of tacrolimus.
    MeSH terms: Diarrhea; Humans; Immunosuppressive Agents; Survival Rate; Liver Transplantation; Organ Transplantation; Tacrolimus; Cyclosporine; Tacrolimus Binding Proteins
  9. Nur Bazlaah B, Nabiha F, Khairuzi S, Amerdad D, Mohd Firdaus H, Ismayudin I
    Med J Malaysia, 2020 11;75(6):736-737.
    PMID: 33219187
    Chronic Urinary Retention (CUR) can be either asymptomatic or associated with lower urinary tract symptoms. There has been no report of case of CUR presented with unilateral scrotal swelling. In the present report, a 69-year-old man came with an abdominal distension and left scrotal swelling. He was initially diagnosed with ascites secondary to a possible malignancy. A diagnosis was established after a computed tomography (CT) scan was done that revealed a giant bladder distension with volume of 10.1 litres. The left scrotal swelling was resolved after catheterization was carried out. There was a possibility that the patient had inferior vena cava obstruction secondary to the huge bladder.
    MeSH terms: Aged; Ascites; Urinary Bladder; Catheterization; Edema; Genital Diseases, Male; Humans; Male; Neoplasms; Tomography, X-Ray Computed; Vena Cava, Inferior; Urinary Retention; Lower Urinary Tract Symptoms
  10. Abdul Satar NF, Cheong EV, Jasmin LPY, Ngu MR
    Med J Malaysia, 2020 11;75(6):738-741.
    PMID: 33219188
    Cancer during pregnancy is a rare condition. We report here a case of a lady diagnosed with nasopharyngeal carcinoma (NPC) at University of Malaya Medical Centre during her first pregnancy conceived via In Vitro Fertilisation (IVF). A multidisciplinary (MDT) meeting among Oncology, Obstetrics, Rheumatology and Otolaryngology teams was conducted to discuss her treatment options. She opted for treatment with Complementary and Alternative Medicine (CAM). This case illustrates the unique challenges in the oncological management of a patient diagnosed with NPC during pregnancy. It also serves as a reminder that the use of CAM in cancer patients is prevalent. It is important for doctors to inquire about use of CAM and to be well-informed about it. Transparent communication and taking cognizance of the goals and concerns of the patients are essential in delivering patient-centred care.
    MeSH terms: Complementary Therapies; Communication; Female; Fertilization in Vitro; Goals; Humans; Medical Oncology; Nasopharyngeal Neoplasms; Obstetrics; Otolaryngology; Physicians; Pregnancy; Rheumatology
  11. Tan TL, Lim SH, Ruslan Mustapa M, Ganeswary R
    Med J Malaysia, 2020 11;75(6):742-744.
    PMID: 33219189
    Methicillin-resistant Staphylococcus aureus (MRSA) purulent pericarditis, characterised by frank pus collection or microscopic pyogenic effusion in the pericardium represents the most serious form of pericardial infection. The route of MRSA acquisition in pericardial abscess commonly occurs via the blood stream infection and it is more commonly observed among immunocompromised individuals. To date, diabetic foot ulcer infection rarely disseminates and becomes a nidus for pericardial infection. Herein, we report an unusual case of MRSA pericardial abscess in a 44-year-old man who presented at Hospital Seri Manjung, Malaysia with cardiac tamponade. Past medical history indicated that he was recently treated for infected diabetic foot ulcer with MRSA bacteraemia one week earlier. Despite adequate pericardial drainage and extended parenteral vancomycin therapy, this case ended in fatality on day 42 of admission due to nosocomial infection. It is hoped that this report serves to increase the vigilance among clinicians that diabetic foot ulcer infections have the potential to progress to pericardial abscess in the presence of MRSA bacteraemia, although they may appear seemingly innocuous at presentation. Systemic vancomycin must be instituted promptly when MRSA bacteraemia is confirmed in order to circumvent the propagation of MRSA.
    MeSH terms: Abscess; Adult; Cardiac Tamponade; Cross Infection; Diabetes Mellitus; Drainage; Humans; Malaysia; Male; Methicillin; Pericarditis; Pericardium; Vancomycin; Bacteremia; Diabetic Foot; Methicillin-Resistant Staphylococcus aureus
  12. Cheo SW, Mohd Zamin H, Low QJ, Tan YA, Chia YK
    Med J Malaysia, 2020 11;75(6):745-747.
    PMID: 33219190
    Stroke is a debilitating disease as it carries significant morbidity especially when it affects the younger population. There are various etiologies of young stroke, namely arterial dissection, cardioembolism, thrombophilia, inherited genetic disorder and vasculitis. Young patient with stroke should undergo complete evaluation to identify the underlying etiology in order to prevent recurrence of stroke. Here, we would like to illustrate a case of Takayasu arteritis presenting as young stroke in a 17-years-old lady with no known medical illness.
    MeSH terms: Adolescent; Female; Humans; Recurrence; Takayasu Arteritis; Thrombophilia; Stroke
  13. Ng RL, Koay HS, Jamil MT
    Med J Malaysia, 2020 11;75(6):748-749.
    PMID: 33219191
    We describe here an infant girl with ductal dependent complex cyanotic heart disease, who required prostaglandin infusion for a total of five months prior to Blalock-Taussig shunt procedure. Her alkaline phosphatase activity was raised after seven weeks being on prostaglandin and only dropped to the normal range seven days after discontinuing prostaglandin infusion. During our review at five months old, her limbs were grossly swollen and radiographic examination showed dense periosteal reaction in the long bones. Based on the clinical findings and investigations, she was diagnosed to have cortical hyperostosis, which is an uncommon side effect of prostaglandin. She underwent right Blalock-Taussig Shunt procedure successfully with no major complications. Unfortunately, she succumbed to infection two months after surgery.
    MeSH terms: Alkaline Phosphatase; Cyanosis; Female; Heart Diseases; Humans; Infant; Prostaglandins; Pulmonary Artery; Reference Values; Hyperostosis; Blalock-Taussig Procedure
  14. Mohd Firdaus MAB, Zulkafli H, Said MR, Hadi MF, Sukhari S, Arjan Singh RS
    Med J Malaysia, 2020 11;75(6):750-751.
    PMID: 33219192
    Pseudotumour of the lung is a rare chest x-ray finding among patients who present with fluid overload. It is caused by loculated pleural effusion in the lung fissures. Unfortunately, the occurrence of pseudotumour can be misleading and sometimes can lead to unnecessary investigation and emotional stress to the patient. We present here a case of a 61-year-old gentleman with a known history of hypertension, diabetes mellitus and dyslipidemia who presented at University Malaya Medical Centre with symptoms of fluid overload and a right middle lobe mass on chest x-ray. The right middle lobe mass disappeared entirely after being treated with aggressive diuretic therapy. A diagnosis of pseudotumour was made and described in this case report.
    MeSH terms: Diabetes Mellitus; Diuretics; Humans; Hypertension; Lung; Malaysia; Male; Middle Aged; Pleural Effusion; Universities; X-Rays; Dyslipidemias
  15. Saren MS, Ping EL, Ping WK
    Med J Malaysia, 2020 11;75(6):752-753.
    PMID: 33219193
    The mother of a 9-month-old female infant complained that her child was unable to pass urine at the same time noticing a mass protruding from the vaginal orifice.The infant had a single episode of vaginal bleeding.The primary concern of the mother was the inability of the daughter to micturate. Malignant germ cell tumour arising from an infant vagina is rare and accounts for about 3% of all paedriatic malignancies. These are also referred to as endodermal sinus tumours or yolk sac tumours, and are mostly the commonest form of infant vaginal malignancies encountered. A diagnosis of endodermal sinus tumour was established based on the histology and raised α-fetoprotein levels.These tumours had Schiller-Duval bodies which are primarily blood vessels surrounded by primordial germ cells and were periodic acid shift (PAS) positive diastase resistant hyaline globules which also stain positive with α- fetoprotein which is an important diagnostic feature. Tumours with high α-fetoprotein levels have a poorer prognosis. However, they respond satisfactorily to chemotherapy.
    MeSH terms: alpha-Fetoproteins; Amylases; Child; Coloring Agents; Female; Humans; Hyalin; Infant; Neoplasms, Germ Cell and Embryonal; Nuclear Family; Periodic Acid; Prognosis; Uterine Hemorrhage; Vaginal Neoplasms; Vulva; Endodermal Sinus Tumor
  16. H'ng MWC, Dennien B
    Med J Malaysia, 2020 11;75(6):754-755.
    PMID: 33219194
    Patients with malignancy who develop superior vena cava (SVC) obstruction may require stenting to relieve their symptoms. Some of these individuals also have an indwelling chemoport for concomitant chemotherapy. We present a case where stenting was accomplished after catheter-assisted deflection of the chemoport catheter tubing via a single groin access. It can save procedure time whilst salvaging the device.
    MeSH terms: Groin; Humans; Neoplasms; Superior Vena Cava Syndrome; Vena Cava, Superior; Stents; Catheters; Chemoradiotherapy
  17. Mohamed AK, Seow CE
    Med J Malaysia, 2020 11;75(6):756-758.
    PMID: 33219195
    Primary sclerosing cholangitis (PSC) is the most common liver disease and known hepatobiliary complication of ulcerative colitis (UC). Concomitant PSC in UC is associated with increased risk of rapid progression of primary sclerosing cholangitis, and malignancy including colon carcinoma as well as hepatobiliary carcinoma. We report a case of a 26-year-old woman who was diagnosed as ulcerative colitis during her second pregnancy. Her liver function test showed a significant elevation of alkaline phosphatase (ALP) and gamma glutamyl transferase (GGT) with other parameters being within normal range. A clinical suspicion of primary sclerosing cholangitis was then made. Magnetic resonance cholangiopancreticography (MRCP) revealed beaded appearance of the right and left intrahepatic ducts with focal narrowing seen at the ducts, suggestive of primary sclerosing cholangitis. She was subsequently started on oral Ursodeoxycholic acid (UDCA) with improvement in her liver function test within 3 weeks of initiation of treatment.
    MeSH terms: Adult; Alkaline Phosphatase; Carcinoma; Colitis, Ulcerative; Digestive System Diseases; Female; gamma-Glutamyltransferase; Humans; Liver Diseases; Liver Function Tests; Magnetic Resonance Spectroscopy; Pregnancy; Reference Values; Ursodeoxycholic Acid; Cholangitis, Sclerosing; Cholangiopancreatography, Magnetic Resonance
  18. Ng BH, Tan YS, Pavitratha P, A Hing C, Zainul NH, Lim CH
    Med J Malaysia, 2020 11;75(6):759-761.
    PMID: 33219196
    A 40-year-old man presented to the Hospital Sultanah Bahiyah, Alor Setar, Kedah, with constitutional and respiratory symptoms. Physical examination and echocardiogram demonstrated massive pericardial effusion. Patient required multiple attempts of pericardiocentesis due to recurrent pericardial effusion. Initial workup including pericardial fluids examination and computed tomography imaging did not reveal any apparent cause. Magnetic resonance imaging showed a suspicious mass infiltrating into the right atrium. Autoimmune screening was negative. Patient was subsequently treated as having tuberculous pericarditis. However, his disease progressed rapidly and he eventually passed away due to right atrial rupture. Postmortem revealed a ruptured right atrial tumour leading to massive haemothorax. Histopathological examination confirmed the diagnosis of primary pericardial angiosarcoma.
    MeSH terms: Pericardial Fluid; Adult; Atrial Fibrillation; Autopsy; Echocardiography; Heart Atria; Heart Neoplasms; Hemangiosarcoma; Hemothorax; Humans; Magnetic Resonance Imaging; Male; Pericardial Effusion; Pericarditis, Tuberculous; Physical Examination; Tomography, X-Ray Computed; Pericardiocentesis
  19. Voon K, Premnath N
    Med J Malaysia, 2020 11;75(6):762-763.
    PMID: 33219197
    COVID-19 has infected more than 10 million people worldwide and it has become one of the biggest challenges in the modern medical history. Wearing of face masks, social distancing, effective hand hygiene and the use of appropriate personal protective equipment are important in flattening the curve of the pandemic. The role of the surgeons in this battle against COVID-19 include curbing the spread of the disease, to protect and preserve the surgical workforce and to ensure the continuance of essential surgical services. We report our experience in dealing with the COVID-19 outbreak in a tertiary surgical centre in the Penang General Hospital in Northern Malaysia.
    MeSH terms: Humans; Masks/supply & distribution*; Disease Transmission, Infectious/prevention & control*; Pandemics*; Surgeons*
  20. Yusoff AR, Ahmad F, Obaid KJ
    Med J Malaysia, 2020 11;75(6):764-766.
    PMID: 33219198
    Coronavirus disease 2019 (COVID-19) is a highly contagious, severe acute respiratory syndrome that poses significant health risks to healthcare providers. A delicate balance is needed between timely intervention for ill patients without apparent COVID-19 infection and the safety of healthcare personnel who provide essential treatment in the midst of the pandemic. We report our experience managing a 70-year-old man who presented with acute gallstone pancreatitis at our hospital during the COVID-19 outbreak in Malaysia. We also describe the safety protocol measures that have been implemented in our institution to protect the healthcare personnel from this disease during endoscopic retrograde cholangiopancreatography. This case illustrates the importance of meticulous planning, risk assessment, effective team communication and strict adherence to recommendations when providing treatment during an unprecedented pandemic.
    MeSH terms: Acute Disease; Aged; Cholangiopancreatography, Endoscopic Retrograde/methods*; Humans; Malaysia/epidemiology; Male; Pancreatitis/epidemiology; Pancreatitis/therapy*; Comorbidity; Gallstones/epidemiology; Gallstones/therapy*; Pandemics
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