MyMedR

Fulltext A young patient with history of Kawasaki disease presenting with triple vessel disease

Lim AL, Lam HY, Kareem BA, Kamarulzaman MH

Med J Malaysia, 2012 Apr;67(2):219-21.

Kawasaki disease is primarily a condition that affects young children and it is associated with cardiac morbidity and mortality. This disease has been known to cause coronary artery aneurysms which occurs as a sequelae of vasculitis. The progression of triple vessel disease in adult which results from cardiac complications from Kawasaki disease is rare. We report a case of a young man with history of Kawasaki disease at infancy presenting with triple vessel disease requiring cardiac bypass surgery at the age of 20 years old.

Fulltext An audit of the Scoliosis Service at Hospital Kuala Lumpur

Chuah SL, Kareem BA, Selvakumar K, Oh KS, Borhan Tan A, Harwant S

Med J Malaysia, 2001 Jun;56 Suppl C:31-6.

PMID: 11814246 MyJurnal

This is a study of patients referred to the Scoliosis Service of Hospital Kuala Lumpur. Three hundred and thirty five (335) consecutive patients who were seen between 1985 and 2000 were reviewed to determine the presentation of scoliosis, the treatment received and the compliance to follow up. Data were determined by measuring the frontal spinal radiographs. Two hundred and ninety eight (298) patients met inclusion criteria. Idiopathic scoliosis accounted for 203 patients (68.1%), 31 (10.4%) were neuromuscular scoliosis; and 44 (14.8%) had congenital scoliosis. Twenty-five point five percent of patients had surgery, 10.4% were treated with brace, while the remaining 69.1% of patients were observed, or had no treatment at all. Congenital scoliosis patients had better compliance compared to idiopathic or neuromuscular scoliosis patients.

Fulltext Aortic valve surgery for aortic regurgitation caused by Libman-Sacks endocarditis in a patient with primary antiphospholipid syndrome: a case report

Le Ho Y, Ahmad Zaidi NA, Salleh A, Abdul Kareem BA

J Cardiothorac Surg, 2021 Apr 17;16(1):92.

PMID: 33865405 DOI: 10.1186/s13019-021-01458-2

BACKGROUND: Antiphospholipid syndrome is an antibody mediated pro-thrombotic state leading to various arterial and venous thromboses. The syndrome can be either primary or secondary to other autoimmune diseases, commonly systemic lupus erythematosus. Cardiac involvement, in particular valvular disease is common in patients with antiphospholipid syndrome, occurring in about a third of these patients. Valvular diseases associated with antiphospholipid syndrome often occur as valve thickening and non-bacterial vegetation or Libman-Sacks endocarditis. Deposits of antiphospholipid immunoglobulin and complement components are commonly observed in the affected valves, suggesting an inflammatory process resulting in valvular vegetation and thickening. Libman-Sacks endocarditis has a high propensity towards mitral valve, although haemodynamically significant valvular dysfunction is rare.

CASE PRESENTATION: We present a successful aortic valve replacement with cardiopulmonary bypass in a 48 years old lady with antiphospholipid syndrome, who has severe aortic regurgitation as a result of Libman-sacks endocarditis. Antiphospholipid antibodies were positive and the clinical data showed both negative cultures and infective parameters. Surgically resected vegetations revealed sterile fibrinous and verrucous vegetations on aortic valve. Valve replacement and the course of cardiopulmonary bypass was uneventful, and the patient was discharged well.

CONCLUSIONS: Classically Libman-Sacks endocarditis is often and more commonly associated with autoimmune diseases such as systemic lupus erythematosus, although it can occur in both primary and secondary antiphospholipid syndrome. It is not a common entity, and it is a frequent underestimated disease as most clinicians do not routinely screen for valvular lesion in patients with antiphospholipid syndrome unless they are symptomatic. However, due to its high prevalence of cardiac involvement, clinicians should have a high index of suspicion in the attempt to minimize cardiovascular and haemodynamic complications. Valve surgery in patients with antiphospholipid syndrome carries considerable early and late morbidity and mortality, usually caused by thromboembolic and bleeding events. The perioperative anticoagulation management and haemostatic aspect of antiphospholipid syndrome present an exceptional challenges to clinicians, surgeons, anaesthetists and laboratory personnel.

Fulltext Audit on radiographs in anterior shoulder dislocations

Lee DJK, Yeap JS, Fazir M, Muhd Borhan TA, Kareem BA

Med J Malaysia, 2005 Mar;60(1):15-20.

PMID: 16250275

The radiographs of 115 anterior shoulder dislocations (100 patients; 74 males, 26 female were reviewed to assess the radiographic views used in the management of this dislocation. Eighty-eight patients (88%) had only the anteroposterior (AP) view, 10 patients had 2 radiographic views taken and only 2 patients had three radiographic views. Hill-Sachs lesions were found in 18%, and glenoid rim fractures in 3% of the patients. A greater tuberosity fracture was found in 18% of the patients. Therefore, the current practice in the management of an acute anterior shoulder dislocation appears to be to perform a single view (AP) pre-reduction radiograph to confirm the diagnosis and a single view (AP) post reduction radiograph to confirm reduction after a close manipulative reduction has been performed. This practice is likely to result in an underestimate of associated Hill Sachs lesion and glenoid rim fractures, but not greater tuberosity fractures.

Fulltext Chronic osteomyelitis due to Burkholderia pseudomallei

Kareem BA, Aiyar S, Marshal DS

Med J Malaysia, 1995 Mar;50(1):116.

PMID: 7752966

Fulltext Compartment syndrome of the calf and foot following a displaced Salter-Harris type II fracture of the distal tibia: a review of the literature and a case report

Yeap JS, Fazir M, Ezlan S, Kareem BA, Harwant S

Med J Malaysia, 2001 Jun;56 Suppl C:66-9.

PMID: 11814253

A 14 year-old boy with an epiphyseal fracture of the distal right tibia and fibula developed compartment syndrome of the calf and foot. The diagnosis of compartment syndrome was delayed and a fasciotomy resulted in uncontrolled infection, which ultimately resulted in an above knee amputation. Constant vigilance is necessary in uncooperative or non-complaining patients to detect the signs and symptoms of compartment syndrome, even where the injury is not often associated with this complication. The difficulties in management, following a fasciotomy for delayed diagnosis of compartment syndrome, are discussed.

Fulltext Disappearing bone disease: a case report

Kareem BA, Das PK, Saad R

Singapore Med J, 1994 Oct;35(5):527-8.

PMID: 7701379

Disappearing bone disease is a rare condition and usually affects young adults. Its aetiology is not known. A case of a 12-year-old female child, who had a fall and sustained a fracture mid shaft of femur and supracondylar region, is reported. On follow-up subsequent X-ray showed extensive osteolysis which was progressively affecting the other side of the pelvic girdle and femur. She was put on trial of calcitonin 50 IU by nasal spray for six months but there was no improvement. However, during the past three and half years the disease process had progressively extended to the other side of pelvic girdle and femur with fatal outcome. To the knowledge of the authors such progression in a short time has not been reported in any case so far.

Fulltext Dysphagia due to anterior cervical osteophytes--a case report

Kareem BA, Sofiyan M, Subramanian S

Med J Malaysia, 2000 Sep;55(3):376-8.

PMID: 11200721

Dysphagia due to osteophytes in a young person is uncommon. We present a rare case of Forestier's disease causing dysphagia in a young lady without other bony involvement. The osteophytes were surgically removed and her symptoms resolved completely.

Fulltext Early remodeling in children's forearm fractures

Qairul IH, Kareem BA, Tan AB, Harwant S

Med J Malaysia, 2001 Dec;56 Suppl D:34-7.

PMID: 14569764

The forearm fracture is a fracture of the upper limb between the elbow and the wrist. It is a common injury in children, accounting for more than half of all children's fractures, and mostly occur when a child falls on the outstretched arm. A difficult clinical problem that often arises is how much angulation can be accepted in the child and how much remodeling will occur. One hundred consecutive cases of forearm fractures that were admitted at Childrens Orthopaedic Ward, Institute of Paediatrics at Hospital Kuala Lumpur between 1st January 1997 to 31st December 1998 were studied. We found that all fractures united 3 to 6 weeks, with a remodeling rate of about 2.5 degrees/month: the proximal fractures having the most potential to remodel. We conclude that the early remodeling potential of forearm fractures in children is 1.5 degrees/month in midshaft fractures and 2.5 degrees/month in distal and proximal fractures. We recommend accepting a 10-20 degree angulation in midshaft fractures, and a 20-30 degree angulation in metaphyseal fractures; based on our study of early remodeling potential.

Fulltext Large papillary fibroelastoma of right atrium, an unusual case of respiratory distress in a young man

Ho YL, Ng PF, Krishinan S, Abdul Kareem BA

J Cardiothorac Surg, 2021 May 29;16(1):151.

PMID: 34051789 DOI: 10.1186/s13019-021-01526-7

BACKGROUND: Papillary fibroelastomas are rare but benign cardiac tumour that are often found on cardiac valvular surfaces. Their clinical manifestations ranging from clinically asymptomatic to substantial complications that are usually secondary to systemic embolism. Multiple theories have been proposed to explain the pathophysiology of its formation.

CASE PRESENTATION: We reported a rare case of large papillary fibroelastoma in the right atrium of a young gentleman which was complicated with pulmonary embolism. Transthoracic echocardiography identified a large pedunculated mass measuring 3.4cmX3.4cmX2cm in right atrium with stalk attached to interatrial septum. The intracardiac mass was resected surgically, which revealed papillary fibroelastoma in histology examination.

CONCLUSION: Differential diagnosis of intracardiac masses requires clinical information, laboratory tests and imaging modalities including echocardiography. Incidentally discovered papillary fibroelastomas are treated on the basis of their sizes, site, mobility and potential embolic complications. Due to the embolic risk inherent to intraacardiac masses, surgical resection represents an effective curative protocol in treating both symptomatic and asymptomatic right sided and left sided papillary fibroelastomas, with excellent long term postoperative prognosis.

Fulltext Management of osteonecrosis of the hip complicated with fracture: a case report

Chua Y, Wazir N, Chiu C, Kareem B

Malays Orthop J, 2012 Jun;6(SupplA):43-5.

PMID: 25279075 MyJurnal DOI: 10.5704/MOJ.1211.011

A 47-year-old gentleman, with underlying seborrhoeic dermatitis that was treated with steroid therapy, and hepatitis B, presented with pain in his right hip. He was diagnosed with stage 2 osteonecrosis of the right hip (Ficat and Arlet classification). Core decompression and bone grafting was performed but recovery was complicated by a surgical site infection. Wound debridement, removal of bone graft and clearance of the bone tunnel were carried out. The patient was allowed to bear weight after surgery. Twelve days later, he developed right hip pain and radiographs showed fractured femur neck; the patient then underwent a two-stage total hip replacement (THR).

Nasopharyngeal carcinoma with spinal secondaries

Elango S, Kareem BA, Chandrasekaran S, Azman N

J Laryngol Otol, 1991 Sep;105(9):772-3.

PMID: 1919352 DOI: 10.1017/s0022215100117281

Nasopharyngeal carcinoma has been reported to have a higher incidence of distant metastases as compared to other head and neck cancers. Distant metastases of nasopharyngeal carcinoma has been reported in the bones, lungs, liver, distant lymph nodes, brain and porta hepatis. This report presents a case of nasopharyngeal carcinoma with secondaries in the extradural space at the thoracic level of the spinal cord which hitherto has been an unreported site.

Fulltext Nerve injuries in anterior shoulder dislocations

Yeap JS, Lee DJK, Fazir M, Kareem BA, Yeap JK

Med J Malaysia, 2004 Oct;59(4):450-4.

PMID: 15779576

A retrospective study was conducted to determine the incidence of nerve injuries in anterior dislocations of the shoulder and to determine if a neurological examination is routinely performed in such cases. One hundred and fifteen shoulder dislocations in 100 patients (74 males, 26 females; mean age 35+/-18 years) were reviewed. Eighty-seven patients were examined for neurological injuries prior to reduction and 8 of these patients (9.2%) were found to have sustained neurological injuries. Following reduction, neurological examination was performed in 85 patients. Three patients who were not examined initially prior to reduction were subsequently found to have nerve injuries after reduction. Seven patients (7%) were not examined for neurological injury both before and after reduction of the dislocation. Eleven patients were found to have sustained nerve injuries in the final analysis. Axillary nerve injuries were the most common, occurring in 8 patients. In conclusion, nerve injuries are common in shoulder dislocations. The importance of performing and documenting the findings of neurological examination anterior shoulder dislocations needs to be reiterated.

Fulltext New clinical sign of cervical myelopathy: Wazir hand myelopathy sign

Wazir NN, Kareem BA

Singapore Med J, 2011 Jan;52(1):47-9.

PMID: 21298241

Cervical spondylotic myelopathy (CSM) represents a spectrum of pathologies with progressive compression of the spinal cord. The clinical signs and symptoms play a key role in diagnosis. The characteristic hand myelopathy signs are of significant clinical importance. The aim of this descriptive study was to report a relatively easy to elicit new hand myelopathy sign. The basis for this is finger and wrist flexor disinhibition, which is used for the spinal specificity of cord compression at or above the C5/6 level.

Overlapping dislocation of pubic symphysis

Dorai CR, Kareem BA

Injury, 1991 Jul;22(4):329-30.

PMID: 1937735

Fulltext Pattern of primary musculoskeletal sarcomas referred to Institute of Radiotherapy and Oncology, Hospital Kuala Lumpur, 1995-1999

Tan LL, Ahmad K, Kareem BA, Harwant S

Med J Malaysia, 2001 Jun;56 Suppl C:52-6.

PMID: 11814250 MyJurnal

An epidemiological study of 101 consecutive musculoskeletal sarcomas seen at the Institute of Radiotherapy and Oncology between 1995 and 1999 inclusive was carried out. The commonest sarcomas seen were osteosarcoma, rhabdomyosarcoma, Ewing's Sarcoma, liposarcoma, leimyosarcoma, malignant fibrous histiocytoma and chondrosarcoma; which collectively accounted for 84.2% of the group. Thirty patients (29.7%) presented with metastases. The commonest site of occurrence was lower extremity with 47.5%, followed by 34.7% in the trunk and peritoneum/axial skeleton, 9.9% in the head and neck region; and 7.90 in the upper extremity. We found no apparent relationship between race and incidence osteosarcoma and Ewing's sarcoma, as was reported by previous workers.

Pediatric empyema thoracis: roles and outcomes of surgery in advanced disease

Ho YL, Jamaluddin MF, Krishinan S, Salleh A, Khamis AY, Abdul Kareem BA

Asian Cardiovasc Thorac Ann, 2020 Mar;28(3):152-157.

PMID: 32122151 DOI: 10.1177/0218492320910932

Fulltext Predictive factors in the evolution of neural deficit in tuberculosis of the spine

Tan SC, Harwant S, Selvakumar K, Kareem BA

Med J Malaysia, 2001 Jun;56 Suppl C:46-51.

PMID: 11814249 MyJurnal

This study was conducted to determine the factors involved in predicting the onset of paraplegia in tuberculosis of the spine. A cross-sectional, case control review of 85 cases of spinal tuberculosis was conducted at the National Tuberculosis Centre in Kuala Lumpur. Sixty-nine of these cases were normal neurologically, whilst 16 cases experienced neural deficit. The data was analysed using backward logistic regression and Fishers exact probability test. The factors studied included symptoms and signs of spinal tuberculosis, common investigations for tuberculosis, and physical factors of the disease. Only the erythrocyte sedimentation rate (ESR) showed a significant difference between the neural deficit and neurologically normal groups. This suggests that the ESR may be a factor in predicting evolution of paraplegia in spinal tuberculosis. In addition, it was noted that a low proportion of patients had positive sputum smear results and bacterial culture growth for mycobacterium tuberculosis suggesting these tests are of limited value for tuberculosis of the spine.

Fulltext Primary osteogenic sarcoma of spine in a 12 year old boy--a case report

Kareem BA, Abdullah WA, Kassim ZM, Myint H, Sengupta

Med J Malaysia, 1990 Sep;45(3):257-9.

PMID: 2152090

A case of primary osteogenic sarcoma of the lumbar spine in child is reported and the difficulties in diagnosis and management are discussed.

Fulltext Risk factors for infection in total hip replacement surgery at Hospital Kuala Lumpur

Yong KS, Kareem BA, Ruslan GN, Harwant S

Med J Malaysia, 2001 Jun;56 Suppl C:57-60.

PMID: 11814251 MyJurnal

Sixty-seven primary THR surgeries in 57 patients between January 1992 and December 1998 were reviewed after a mean follow-up of 35.9 months. The rate of superficial and deep wound infections were 11.9% and 1.5% respectively. The most common organism in superficial wound infection was Staphylococcus aureus. The factors that were significantly associated with superficial wound infection were diabetes mellitus (p= 0.0230) obesity (p=0.0088). The patients who developed superficial wound infection have a significantly longer duration of surgery compared to patients without infection (p=0.014). However, there was no significant difference between the mean age among patients with and without superficial wound infection (p=0.814).

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