Browse publications by year: 2021

Esophageal cancer epidemiology, diagnosis, and management in Sudan - A review

Musa IH, Musa TH, Musa HH, Ahmed ME

Med J Malaysia, 2021 09;76(5):691-697.
PMID: 34508376

INTRODUCTION: In Sudan, cancer a common health challenge, is the leading cause of death after malaria and viral pneumonia. The aim of the review is to determine the risk factors associated with esophageal cancer (EC) among Sudanese population.
METHODS: All published online data concerning EC epidemiology, diagnosis, and management in Sudan were studied.
RESULTS: The prevalence of EC in Sudan is ranked fourth among cancer types in males and fifth in females. The squamous cell carcinoma is more predominant than adenocarcinoma. The dietary, dysplasia and teeth loss, cigarette smoking, age, sex, GERD, genetic and environmental interactions remain a risk for developing EC in clinical practice. A significant challenge for treatment is that most of EC patients were often diagnosed in advanced stages due to the lack of early clinical symptoms. Management of EC depends on patient fitness and tumor stage, endoscopic removal was used for early tumors, while chemotherapy, chemo-radiotherapy, surgical resection, or combinations of these were used for advanced tumors. Despite improvements in the management and treatment of EC patients, the general outcome remains very poor. Furthermore, using molecular techniques to better understand the etiology of EC, it may assist in identifying complicated and critical issues and improve therapy towards a new treatment strategy.
CONCLUSION: The remarkable factors associated with EC among Sudanese are geographical variation, environmental factors, ethnic differences, dietary and social habits.
Trends in antimicrobial resistance in Malaysia

Naeemmudeen NM, Mohd Ghazali NAN, Bahari H, Ibrahim R, Samsudin AD, Jasni AS

Med J Malaysia, 2021 09;76(5):698-705.
PMID: 34508377

INTRODUCTION: Antibiotic resistance is a burgeoning problem worldwide. The trend of bacterial resistance has increased over the past decade in which more common bacteria are becoming resistant to almost all the antibiotics currently in use, posing a threat to humans and even livestock.
METHODS: The databases used to search for the relevant articles for this review include PubMed, Science Direct, and Scopus. The following keywords were used in the search: Antimicrobial resistance, Malaysian action plan, antibioticresistant bacteria, and Malaysian National Surveillance on Antimicrobial Resistance (NSAR). The relevant articles published in English were considered.
RESULTS: The antibiotic-resistant bacteria highlighted in this review showed an increase in resistance patterns to the majority of the antibiotics tested. The Malaysian government has come up with an action plan to create public awareness and to educate them regarding the health implications of antibiotic resistance.
CONCLUSION: Antimicrobial resistance in Malaysia continues to escalate and is attributed to the overuse and misuse of antibiotics in various fields. As this crisis impacts the health of both humans and animals, therefore a joined continuous effort from all sectors is warranted to reduce the spread and minimize its development.
CT and MRI findings of acute calculous cholecystitis and its complications in Singapore: A pictorial review

Wee NK, Cheong WSC, Low HM

Med J Malaysia, 2021 09;76(5):706-713.
PMID: 34508378

INTRODUCTION: Acute cholecystitis (AC) is a common problem encountered in surgical practice. This occurs due to obstruction of the cystic duct by calculi resulting in inflammation of the gallbladder. Increasingly, contrast enhanced computed tomography (CECT) and Magnetic Resonance Imaging (MRI) scans are being used for assessment. While the imaging features of AC are well recognized and extensively described in the literature, radiological features of the rarer complications related to AC such as pseudoaneurysm formation and gallbladder volvulus are less well known. We aim to describe these rarer findings in our pictorial review, to better educate the clinician and radiologist, such that timely diagnoses can be reached, and relevant management can be affected.
METHODS: A collection of cases showing the common acute gallbladder pathologies and complications such as acute cholecystitis, gangrenous cholecystitis, emphysematous cholecystitis, haemorrhagic cholecystitis, Mirizzi's syndrome, gallbladder perforation and abscess formation, were collected between July 2016 and March 2018 at two different medical institutions in Singapore. In addition, rarer cases of gallbladder volvulus and vascular complications such as cystic artery pseudoaneurysms and vessel erosions, were also followed up.
RESULTS: The CT and MRI imaging features of these conditions were discussed, with key diagnostic imaging features emphasized.
CONCLUSION: Acute gallbladder pathologies are commonly encountered in day-to-day radiology practice. Knowledge of the rarer gallbladder pathologies and their key imaging features will help the radiologist, in particular, the on call radiologist in training, improve diagnostic accuracy and allow for timely management.
Modifications to Hepatopancreatobiliary surgical services during COVID-19 partial lockdown in a hospital in northern Malaysia

Hassan R, Nijhar JS, Leow VM, Manisekar S

Med J Malaysia, 2021 09;76(5):714-717.
PMID: 34508379

Maintaining hepatopancreatobiliary (HPB) services during the initial phase of a pandemic in a state referral hospital for COVID-19 presents a few challenges, especially when a nationwide, government-issued partial lockdown is in enforcement. We describe the adaptations to our practice to maintain the services whilst ensuring safety of patients and staff, by postponing non-urgent clinic cases, grouping our staff to two mutually exclusive teams that work on alternate shifts and selecting HPB operative cases according to the modified Risk Urgency Decision Matrix.
Human papillomavirus assay design is a crucial consideration for self-collection based cervical screening

Hawkes D

Med J Malaysia, 2021 09;76(5):718.
PMID: 34508380

No abstract provided.

MeSH terms: Female; Humans; Mass Screening; Specimen Handling; Papillomaviridae; Alphapapillomavirus*; Early Detection of Cancer
Lessons learned from chemotherapeutic and immunosuppressant induced Hepatitis B reactivation - a case series

Nida' Ul-Huda A, Haniza O

Med J Malaysia, 2021 09;76(5):719-724.
PMID: 34508381

This case series is to create awareness among clinicians on the importance of Hepatitis B screening prior to administration of chemotherapeutic agents and immunosuppressant in preventing Hepatitis B reactivation (HBVr). We also highlight the importance of identifying patients who are at risk of HBVr and when to initiate antiviral prophylaxis based on the current evidence-based guidelines. The case series consists of four patients seen in Hospital Selayang, Malaysia who developed fulminant liver failure secondary to chemotherapeutic agents or immunosuppressant induced HBVr. HBVr is likely to be of increasing clinical significance as potent immunosuppressive regimens are used more widely across all medical specialties. Clinicians should be made aware of the potential risk of patients developing fulminant liver failure following HBVr and its association with high morbidity and mortality. In the era of inexpensive Hepatitis B blood screening tests and safe potent antivirals, there is now a paradigm shift to make the test compulsory to screen all patient prior to initiation of chemotherapeutic agents or immunosuppressive therapy. Antiviral prophylaxis may be offered to more patients who are at risk of HBVr and the duration of both prophylaxis and subsequent monitoring may be extended until 6 to 18 months following completion of treatment.
Temporal bone squamous cell carcinoma: A change in treatment

Ngu CYV, Mohd Saad MS, Tang IP

Med J Malaysia, 2021 09;76(5):725-730.
PMID: 34508382

Temporal bone squamous cell carcinoma (TBSCC) is a rare head and neck malignancy with the incidence 0.8 -1.0 cases in 1 million population. We are reporting a case series on the TBSCC cases that were operated on at Sarawak General Hospital, Malaysia. Ten patients were identified and collected with the presentation and type of surgery performed. It has been challenging for us to manage with recorded 2 years surviving in 6 out of 10 patients operated within this period. An adequate management with proper surgical resection of tumour and radiotherapy can extend the life expectancy for TBSCC patients.
Group A Streptococcus puerperal sepsis with invasive neonatal infection: A fatal case

Siti Hafsyah MH, Ibrahim NR, Noraida R, Ismail AA, Anani Aila MZ, Hajissa K, et al.

Med J Malaysia, 2021 Sep;76(5):731-733.
PMID: 34508383

Neonatal invasive Group A Streptococcus (GAS) infection is a rare occurrence nowadays. Prior maternal vaginal colonization is an important factor in early neonatal disease. We report a case of invasive and fatal infection in a neonate. At Day 1 of life, a term baby was found to be lethargic, with poor feeding, and later became unresponsive. Consequently, the baby was immediately brought to the Emergency Department of Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan via ambulance. Despite the active resuscitation efforts in the hospital, the baby died. An autopsy was carried out to determine the cause of death. The mother was noted to have puerperal pyrexia secondary to vaginal discharge. Her high vaginal swab culture was positive for GAS. GAS was also isolated from the intracardiac blood, pleural fluid, peritoneal fluid, and umbilical swab of the baby, giving evidence to the aetiology of the mortality. Vaginal colonization of GAS is an important factor for high morbidity and mortality for both mother and infant due to its invasiveness and virulence.
It is tuberculosis or melioidosis? A clinical diagnostic dilemma

Jamani NA, Mohd Nor FH, Yatim Y

Med J Malaysia, 2021 Sep;76(5):734-736.
PMID: 34508384

Pulmonary Tuberculosis (PTB) is an endemic disease in Malaysia and continues to cause great morbidity and mortality. However, the diagnosis and treatment may pose a challenge to the attending physician since other diseases such as melioidosis can mimic tuberculosis. Hence, the final diagnosis should be done thorough history of illness, physical examination, investigations, and interpretation of findings. We present here a case of a 27-year-old man who presented at our primary care clinic with underlying diabetes mellitus whose symptoms were suggestive of PTB, and who was treated with anti-tuberculosis but later his sputum grew culture Burkholderia pseudomallei.
Patency of permanent vascular access creation in paediatric patients with end stage renal disease

Ho HL, Halim AS, Mat Saadk AZ, Sulaiman WAW, Ilias MI

Med J Malaysia, 2021 Sep;76(5):737-740.
PMID: 34508385

Renal transplant is the first-line therapy in paediatric patients with end-stage renal disease (ESRD). Wong HS and Goh BL reported up to 79% of 1061 paediatric patients still require long-term haemodialysis (HD).1 The lack of deceased and living donors is attributable to the poor awareness, cultural and religious grounds. Permanent vascular access (PVA) in paediatrics therefore, serves more as a long term treatment rather than a bridging therapy. We observed 5 children and an adolescent, all with previous indwelling catheters, who underwent arteriovenous fistula (AVF) creation and report the outcomes. The aim of this report is to determine the factors that influence the longterm patency of paediatric AVF. Factors such as body weight, vessel diameter, preoperative preparations, microsurgical technique and postoperative maintenance are discussed. In addition, considerations on the choice and timing of PVA is highlighted.
Elephant attack - A rare case of survival

Syahmi WM, Mafauzy MM, Baharuddin KA, Ikhwan SM, Sayuti KA, Mohd Shukruddeen S

Med J Malaysia, 2021 Sep;76(5):741-743.
PMID: 34508386

Conflict of human-wild elephant is not uncommon in Malaysia. Most of the human victims usually succumb to death due to internal organ injuries. Here we report a case of a woman who was the victim of an elephant attack and successfully survived to share our experience in managing this type of polytrauma.
Pediatric intrathoracic migration of ventriculoperitoneal shunt catheter post TB meningitis: A case report

Lee WL, Azmi A, Fadzlishah Johanabas R

Med J Malaysia, 2021 Sep;76(5):744-746.
PMID: 34508387

Ventriculoperitoneal shunt (VPS) is a common procedure in neurosurgery for Cerebrospinal Fluid (CSF) diversion. It is associated with various complication. One of the rarer complications is migration of the shunt catheter. The incidence is higher in the paediatric population, up to 71.2% compared to adults 28.8%. We present a case of a 1 year 4 months old boy post TB meningitis with intrathoracic shunt migration 2 months after implantation of VPS. The child presented with upward gaze palsy, on and off productive cough and fever. He had a ventriculoperitoneal shunt inserted 2 months before, when he was diagnosed and treated for TB meningitis. Radiological imaging revealed the distal catheter tip was at the right lung with pneumothorax. The shunt was removed and after confirming that there is no active infection, a new ventriculoperitoneal shunt was reinserted.
Complete resolution of constrictive pericarditis after coronary bypass surgery

Paneer SKM, Christina SR, Adli Azam MR, Balachandran K, Deventhiran P

Med J Malaysia, 2021 Sep;76(5):747-749.
PMID: 34508388

Classical constrictive pericarditis (CP) is an unusual and rare complication after coronary artery bypass grafting. It can be transient, progressive or fixed form of cardiac constriction. However recently recognized transient variant of constrictive pericarditis can be managed with medical therapy, though other progressive and irreversible forms may require pericardiectomy. We describe a 65-year-old male patient who developed a classical but a very early transient CP, just within two weeks as a result of post cardiac injury syndrome after coronary bypass surgery. The patient had a complete recovery following medical treatment.
Acute necrotizing encephalopathy in a child secondary to dengue fever: A case report

Cheo SW, Low QJ, Teh YG, Rajahram GS, Mohd Zain NR, Chia YK

Med J Malaysia, 2021 Sep;76(5):750-752.
PMID: 34508389

Dengue fever (DF) is an important public health problem, and it is now endemic in more than 100 countries worldwide. Dengue associated neurological complication is estimated to be affecting 0.5 to 6.2% of patients. Even though this is rare, neurological manifestation of DF is an increasingly recognized entity in recent years due to significant mortality and morbidity reported/seen. Reported central nervous system manifestations due to dengue include encephalitis, encephalopathy, myelitis, myositis, acute disseminated encephalomyelitis, Guillain-Barré syndrome, stroke and etc. We report here a case of acute necrotizing encephalopathy secondary to DF in a previously healthy 12-year-old girl.
Vitamin C deficiency in a picky eater child

Fickrey A, Muhd Helmi MA, Azian AA, Shukrimi A, Fadzil A

Med J Malaysia, 2021 Sep;76(5):753-756.
PMID: 34508390

Vitamin C deficiency or scurvy is an uncommon condition that occurs in poorly developed countries or in refugee camps. Nonetheless, in countries where food is readily available, like Malaysia, occasionally there are cases of vitamin C deficiency reported. Although it was primarily reported in children with special needs or learning disability, scurvy is encountered in children with normal development, among the severe picky eaters. We present here case of a nine-year-old picky-eating boy with scurvy. The development of scurvy in this child took several years, especially after he became a very selective eater at the age of five. The child had displayed limping when walking with knee-joint pain before he came to a primary hospital. However, his condition was not diagnosed promptly and progressively worsened until he was unable to walk. Thus, it is crucial to recognize scurvy in children who limps and are severe picky eaters.
A case of lupus nephritis flare-up in severe COVID-19 infection

Yusuf AS, Cheong XK, Rozita M, Periyasamy P, Ruslinda M

Med J Malaysia, 2021 09;76(5):757-761.
PMID: 34508391

The novel Coronavirus disease 2019 (COVID-19) had rapidly spread and became a worldwide pandemic since its detection in Wuhan, China. The disease has caused significant morbidity and mortality, particularly among patients with comorbidities. The current treatment involves supportive management alongside antiviral therapy and immunosuppressant therapy in severely affected patients. We describe a case of a patient with underlying lupus nephritis (LN) who presented with severe COVID-19 infection and concomitant LN flare with acute kidney injury (AKI). The patient was treated with antiviral therapy, Favipiravir, considering his risk of developing severe COVID-19 infection. As the patients would usually have AKI alongside LN flare, we administered initial steroid therapy at a lower dose (Methylprednisolone 50mg daily) and oral hydroxychloroquine despite the initial concerns on immunosuppressant usage in COVID-19 infections. Although our patient recovered relatively well from COVID- 19 infection, he continued to have positive reverse transcriptase-polymerase chain reaction (RT-PCR) nasopharyngeal swab for COVID-19 up to 29 days of illness. His kidney function stabilised despite having persistent nephrotic range proteinuria. Hence, the attending team decided to pulse the patient with a high dose steroid (IV Methylprednisolone 250mg OD for three days) after two weeks of illness despite the persistent positive swab. The patient's condition continued to improve, and this case illustrates an approach in treating COVID-19 with concomitant active immune-mediated glomerulonephritis. We find that it is safe to institute high dose immunosuppressant in recovered COVID-19 patients two weeks after the illness.
A challenging road to diagnosing transthyretin cardiac amyloidosis and using technetium-99m pyrophosphate bone scintigraphy in nuclear cardiology - A case report

Kavita A, Abdul Onny MA, Suppiah S, Abdul Aziz AF, Hashim H, Raja Shariff RE, et al.

Med J Malaysia, 2021 Sep;76(5):762-767.
PMID: 34508392

Cardiac amyloidosis (CA) is a rare form of protein deposition disease, leading to restrictive cardiomyopathy that often presents with signs and symptoms of unexplained heart failure with preserved ejection fraction (HFpEF). There are two main subtypes of CA, namely light chain amyloidosis (AL) and transthyretin amyloidosis (ATTR), which are conventionally confirmed by endomyocardial biopsy (EMB). The prognosis and treatment of the subtypes differ extensively, making it crucial to distinguish between the two. Although echocardiography (ECHO) and cardiac magnetic resonance imaging (CMR) are useful to aid in the diagnosis, they are unable to differentiate between the subtypes. Advantageously, the transthyretin cardiac amyloidosis (ATTR-CA) subtype can be diagnosed based on nuclear medicine bone scintigraphy imaging using Technetiumlabelled bone-seeking radiotracers. We report a case of a previously well, elderly gentleman who presented with acute heart failure symptoms, whereby ECHO findings were suspicious for CA. Technetium-99m pyrophosphate (99mTc- PYP) bone scintigraphy performed with complementary single photon emission computed tomography/computed tomography (SPECT/CT) at three hours post-injection revealed radiotracer uptake in the myocardium that was higher than the skeletal bone uptake. This corresponded to Perugini score of 3 along with an increased heart to contralateral lung ratio (H:CL) of 1.69. The bone scintigraphy findings together with his symptoms, ECHO, CMR, and laboratory results enabled the diagnosis of ATTR-CA to be made. In summary, bone scintigraphy offers a reliable and non-invasive method for the diagnosis of ATTR-CA. We also highlight the diagnostic pitfalls and recommendations in reporting bone scintigraphy for the indication of typing cardiac amyloidosis.
Luc's abscess in Down syndrome - A case report

Abdul Azim Al-Abrar AK, Nik Adilah NO, Hazama M

Med J Malaysia, 2021 Sep;76(5):768-770.
PMID: 34508393

Luc's abscess is an exceedingly rare complication of otitis media, where the middle ear infection spreads extratemporally causing a subperiosteal collection under the temporalis muscle. It is known as a benign complication of otitis media as it is thought not to involve the mastoid bone in comparison to other types of extratemporal abscesses related to otitis media. We describe a challenging case of a 19-year-old male with Down syndrome diagnosed with Luc's abscess involving the mastoid bone. A high-resolution computed tomography scan is important to determine the extent of the abscess, with or without mastoid involvement, and the presence of complications. These findings will then help to determine the surgical options. Drainage of abscesses is a simple, initial, and conservative approach but less effective compared to mastoidectomy. 'Mastoidsparing' approach should only be considered if there is complete resolution after a simple drainage and antibiotic treatment.
Columella necrosis in a child secondary to nasal continuous positive airway pressure during neonatal period

Priyanka M, Khadijah MN, Jeyanthi K

Med J Malaysia, 2021 Sep;76(5):771-773.
PMID: 34508394

The advent of continuous positive airway pressure ventilation as a mode of treatment for respiratory distress syndrome for premature infants has increased the risk of nasal injuries such as pressure necrosis. We describe a case of a 24-week infant who received CPAP ventilation as a mode of ventilatory support for respiratory distress syndrome and the complication of pressure necrosis of the columella. There are many factors that predispose an infant receiving CPAP ventilation to nasal injury. Many strategies can be employed to reduce the incidence of nasal injuries such as the use of nasal barrier dressings, the use of nasal high flow oxygen (nHF) cannula instead of CPAP ventilation, and the use of nasal masks instead of nasal prongs for CPAP ventilation delivery. The treatment of pressure necrosis can be either medical or surgical. The use of ointments or growth sprays can be used in cases of skin breakdown. Surgical reconstruction can be offered in cases of nasal deformity.
Massive penile lipogranuloma following olive oil injections

Fadya Nabiha AS, Fam XI, Fatimah MN, Md Hud MZ

Med J Malaysia, 2021 Sep;76(5):774-776.
PMID: 34508395

Penile self-injections are performed with the purpose of increasing the size of the penis. Commonly, mineral oils or mineral oil-like substances are used for this purpose. However, there are very few publications describing on the complications from vegetable oil injections especially olive oil. Following the injection, the resulting deformity of the male genitalia is described as penile paraffinomas lipogranuloma of the penis. We would like to report a case of penis augmentation by a 50-year-old gentleman using olive oil injections that caused a massive, severely deformed of the penis and scrotum. Surgical excision and reconstruction was done. The patient was discharged after five days postoperatively, with full graft take. Injecting any oily substances into the human body is hazardous. The differential diagnosis of nodules following injections should be kept in mind and in doubtful cases, biopsy should be done. Regular follow-up is essential to prevent the further inflammatory event. Safe and legal procedures should be implemented for penile enlargement so as to avoid self-injections and in the prevention of such debilitating problems.

External Links