Displaying publications 1 - 20 of 159 in total

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  1. Non-secretory multiple myeloma with diagnostic challenges
    Hamidah NH, Azma RZ, Ezalia E, Das S, Umar NA, Swaminathan M, et al.
    Clin Ter, 2010;161(5):445-8.
    PMID: 20949241
    Non-secretory multiple myeloma (NSMM) is a rare variant of the classic form of multiple myeloma (MM). In NSMM, no monoclonal gammopathy can be detected in serum or urine by conventional techniques, making the diagnosis more difficult. We describe a 71-year-old man who had been diagnosed and treated for granulocytic sarcoma one year prior to his recent problems of progressive low-back pain of two months duration. Skeletal X-rays showed diffuse osteolytic lesions with multiple pathological fractures but there was no monoclonal gammopathy in the serum or urine. The biopsy of the lytic lesion on the upper part of the femur showed infiltration by abnormal plasma cells. A diagnosis of NSMM was made and he was treated with chemotherapy. The early diagnostic difficulty and the challenges faced regarding the case are discussed.
  2. Training exposure and confidence level among medical officers: Does an Emergency Physician make a difference?
    Zakiah MJ, Nidzwani M, Hanizah N, Affirul CA
    Clin Ter, 2016;167(1):e1-5.
    PMID: 26980635 DOI: 10.7417/T.2016.1911
    The training of emergency medical officers has always been informal. Only recently, the presence of emergency physician may have a positive influence in their training and development. This study aims to determine the effect of Emergency Physician (EP) presence on the training exposure and confidence level of medical officers in their practice.
  3. Assessment of documentation of DSM-IV-TR Criteria A for diagnosis of schizophrenia in psychiatric unit, tertiary hospital, Malaysia
    Maung K, Ohnmar H, Than W, Ramli M, Najwa Hanim MR, Ali Sabri R, et al.
    Clin Ter, 2015;166(2):87-90.
    PMID: 25945438 DOI: 10.7417/CT.2015.1823
    OBJECTIVE: The purposes of this study were to investigate the documentation of the DSM-IV-TR- Criteria A in diagnoses of schizophrenia and to identify the symptoms associated with over diagnosis of schizophrenia.

    METHOD: This study involved a retrospective review and analysis of data from case notes.

    RESULTS: Data of 107 newly diagnosed patients with schizophrenia were keyed in and analyzed using SPSS v 19. The cases were then evaluated for the use of the DSM-IV-TR- Criteria A. Over diagnosis was noted in 37.39% of the patients. Disorganised behaviour (12.5%), affective flattening (12.5%), hallucination (16%) and non-bizarre delusion (18.3%) significantly contributed to the over-diagnosis of schizophrenia. Symptoms such as non-bizarre delusion and hallucination were the most commonly used in over-diagnosing schizophrenia and were statistically significant with p ≤0.05.

    CONCLUSIONS: There was a significant lack of DSM-IV-TR Criteria A among the data documented to diagnose schizophrenia and non-bizarre delusion and hallucination were the most commonly used in over-diagnosing schizophrenia. This key problem needs to be addressed. The reliability of a diagnosis is indispensable and achievable with the proper clinical application of DSM-IV-TR Criteria A. The DSM-IV-TR Criteria have been perceived to be useful and reliable and is most widely used throughout the world.
  4. A study of JAK2 (V617F) gene mutation in patients with chronic myeloproliferative disorders
    Hamidah NH, Farisah NR, Azlinda AB, Wong FL, Das S, Fadillah SA, et al.
    Clin Ter, 2012;163(2):109-13.
    PMID: 22555824
    Chronic myeloproliferative diseases (MPDs) are heterogenous group of haematological malignant disorders. It is now a well recognized fact that the JAK2 (V617F) mutation occurs in majority of the patients with polycythaemia vera (PV) and half of those with myelofibrosis and essential thrombocythaemia. The presence of JAK2 (V617F) mutation is considered an important criterion for the exclusion of secondary-reactive from clonal disorders. In the present uni-institutional study, we analyzed the JAK2 (V617F) mutation status in the ethnic Malay and Chinese patients who were diagnosed as MPDs.
  5. Risk of mental health disorders among farmers involved in palm plantation occupation
    Leonard JH, Ali JE, Vikram M, Saraswathy V, Hanif FM, Nihayah M, et al.
    Clin Ter, 2013;164(5):403-6.
    PMID: 24217825 DOI: 10.7417/CT.2013.1603
    The aim of this study was to define mental health status of palm plantation farmers in Muar, Johor, Malaysia.
  6. Prolonged writing task: comparison of electromyographic analysis of upper trapezius muscle in subjects with or without neck pain
    Leonard JH, Kok KS, Ayiesha R, Das S, Roslizawati N, Vikram M, et al.
    Clin Ter, 2010;161(1):29-33.
    PMID: 20393675
    Work related musculoskeletal disorders represent a serious public health problem as it is a leading cause for disability and absenteeism in workers. The main purpose of the present quasi-experimental study was to compare the muscle activity of the upper trapezius in subjects with neck pain and compare it to those of normal subjects.

    Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
  7. Information needs of family members of critically ill patients in intensive care unit of a tertiary hospital
    Noor Siah AA, Ho SE, Jafaar MZ, Choy YC, Das S, Ismail SM, et al.
    Clin Ter, 2012;163(1):63-7.
    PMID: 22362236
    BACKGROUND AND AIMS. The experience in intensive care unit (ICU) has created an intense emotional situation both to patients and their family members. The aim of this study was to determine the family members information needs of critically ill patients in ICU.

    MATERIALS AND METHODS:
    A descriptive cross-sectional study was conducted on 200 family members of patients admitted in ICU. A face to face interview was conducted and a self-report questionnaire of the Critical Care Family Needs Inventory (CCFNI) was used.

    RESULTS:
    Findings reported CCFNI five sub-attributes that ranked from highest to lowest included: support (mean 39.13 ± 6.189); proximity (mean 27.17 ± 3.384); information (mean 24.25 ± 3.093); assurance (mean 22.67 ± 1.862) and comfort (mean 16.24 ± 2.776). There were no significant differences in needs between family members with different gender (p >0.05). However, there were significant differences in support needs between family members with admission to ICU with (t=-2.111; p <0.05). There were significant differences in assurance needs (F=3.542; p <0.05) and information needs (F=3.681; p <0.05) between family members with age. There were no significant differences in needs between family members with different education level (p >0.05) whereas assurance needs were significant differences with education level of (F=3.542; p <0.05).

    CONCLUSION:
    The results suggest that family members perceived support and proximity as the most crucial need. Comfort need was viewed as least important. Although this study was conducted in a tertiary hospital, the findings could still provide insight for nurses to improve the delivery of care to patients and family members.
  8. Abdominal wall reconstruction after resection of an enterocutaneous fistula with an island pedicled anterolateral thigh perforator flap. Case report
    Ali F, Safawi EB, Zakaria Z, Basiron N
    Clin Ter, 2013;164(5):413-5.
    PMID: 24217827 DOI: 10.7417/CT.2013.1605
    Entero-cutaneous fistula resulting from a locally invasive large bowel carcinoma is a difficult surgical challenge. En-bloc resection of the involved organs and the entero-cutaneous fistula tract with a healthy tissue margin will result in a composite abdominal wall defect that requires closure. Reconstructive surgical options include primary closure, components separation and the use of local, regional or free flaps with or without prosthetic mesh. We report a case of an abdominal enterocutaneous fistula secondary to a locally invasive sigmoid carcinoma, which was reconstructed with a pedicled antero-lateral thigh perforator (ALT) flap. To our knowledge, this is the first case of a malignant entero-cutaneous fistula, which was reconstructed with an ALT flap.
  9. Effect of Cissus quadrangularis Linn on the development of osteopenia induced by ovariectomy in rats
    Potu BK, Nampurath GK, Rao MS, Bhat KM
    Clin Ter, 2011;162(4):307-12.
    PMID: 21912817
    The aim of our study was to see the efficacy of petroleum ether extract of Cissus quadrangularis (CQ) on development of osteopenia in ovariectomy induced Wistar rats.
  10. Perianchor radiolucency following PEEK suture anchor application associated with recurrent shoulder dislocation: a case report
    Shahrulazua A, Duckworth D, Bokor DJ
    Clin Ter, 2014;165(1):31-4.
    PMID: 24589948 DOI: 10.7471/CT.2014.1658
    The authors describe a case of a 25 year old male who suffered recurrent shoulder dislocations after a symptom-free period following an initial arthroscopic shoulder stabilisation using PEEK suture anchors to repair the Bankart and SLAP lesions. The MRI and CT scans showed perianchor radiolucency around all of the previously placed PEEK suture anchors. It is believed that his recurrent shoulder instability was related to this radiological finding although the exact pathomechanism of the osteolysis is not clear. To our knowledge, this is the first reported case of perianchor radiolucency after the use of a PEEK suture anchor.
  11. Primary biliary cirrhosis and auto immune hepatitis overlap syndrome mimicking cholangiocarcinoma
    Adel A, Zamri Z, Azlanuddin A, Bong JJ
    Clin Ter, 2013;164(6):e493-5.
    PMID: 24424229 DOI: 10.7417/CT.2013.1643
    Primary Biliary Cirrhosis (PBC) and Auto Immune Hepatitis (AIH) are autoimmune diseases of the liver which highlighted with slow destructive process of intra hepatic small bile ducts. As a result of these damages cholestasis and over the time tissue damage will happen, which leads to scarring, fibrosis and finally cirrhosis. Some patients may present with clinical and biochemical features of both conditions, which is called "Overlap syndrome". Here we are reporting a case of PBC-AIH overlap syndrome that primarily diagnosed as gallbladder carcinoma and went under operation and finally histological examination revealed to be PBC.
  12. White gauze test: a novel technique in preventing post-hepatectomy bile leak
    Yugasaravanan K, Affirul CA, Zamri Z, Azlanudin A, Bong JJ
    Clin Ter, 2015;166(2):e102-4.
    PMID: 25945439 DOI: 10.7417/CT.2015.1828
    BACKGROUND: Post-hepatectomy bile leak may lead to undesired morbidity. Multiple methods have been employed to identify this leak but can be inconclusive and taxing. This novel white gauze test is a simple and reliable method.

    MATERIALS AND METHODS: This is a prospective study performed from January 2010 until March 2011. All open hepatic resection were included. Dry white gauze is compressed onto the transected surface and observed for bile staining. The leaking duct is repaired immediately upon detection. The process is repeated until negative. Drain was removed on postoperative day-5. Post-operative bile leak is defined as: 1. Bilirubin concentration of the drain fluid is 3 times or higher than serum; 2. Presence of intra-abdominal bile collection on imaging and upon drainage; 3. Bile leak demonstrated on postoperative cholangiography.

    RESULTS: 42 patients were recruited. Seven (16.7%) patients were cirrhotic with Child-Pugh A. White gauze test were positive for intra-operative bile leaks in 29 patients (70%), which were primarily repaired. As a result, there was no postoperative bile leak in this series. One mortality was detected in this series due to postoperative pancreatic fistula and multi organ failure.

    CONCLUSIONS: The White Gauze Test is a useful method for the prevention of bile leakage after hepatic resection. It is safe, quick and cheap.

  13. Preconception counseling in the prevention of fetal alcohol syndrome: a unique window of opportunity
    Das S, Rao V, Chaudhuri JD
    Clin Ter, 2009;160(4):315-22.
    PMID: 19795087
    The role of alcohol in the causation of Fetal Alcohol Syndrome (FAS) has been firmly established. In most cases events leading to its occurrence have been set into motion prior to conception. Alcohol consumption during pregnancy, the sole causative agent of FAS, can therefore be prevented even prior to conception by implementation of preconception counseling (PCC). The present review examines the important issues involved in the implementation of PCC for the prevention of FAS which can be of immense help to the affected population.
  14. Fulltext Mechanical thrombolysis as an adjunct therapy to management of portal vein thrombosis following Radio Frequency Ablation
    Hairol AO, Affirul CA, Azlanudin A, Zamri Z, Razman J, Choi SY
    Clin Ter, 2017 Jan-Feb;168(1):e5-e7.
    PMID: 28240755 DOI: 10.7417/CT.2017.1974
    Radiofrequency ablation (RFA) has evolved to become the treatment of choice for non-resectable recurrent colorectal liver metastasis. It is however, not without complications. Portal vein thrombosis following RFA is rare but can be fatal to the outcome of the patient. Here, we present a case of a 66-year-old man who developed portal vein thrombosis following RFA. CT scan revealed a left portal vein thrombosis. This case report highlights the challenges and multimodal treatment of portal vein thrombosis following Radiofrequency ablation (RFA) in a cirrhotic patient.
  15. Development and validation of non-adherence to pulmonary rehabilitation questionnaire: a clinical tool for patients with chronic obstructive pulmonary diseases
    Ayiesah R, Leonard JH, Chong CY
    Clin Ter, 2014;165(3):123-8.
    PMID: 24999563 DOI: 10.7417/CT.2014.1708
    OBJECTIVE: Non-adherence is a serious issue among the participants in pulmonary rehabilitation program (PRP). Till date, no clinical tool is available to screen participants who will show poor adherence towards PRP. This study aimed to develop and validate a tool called "Adherence to Pulmonary Rehabilitation Questionnaire (APRQ)", a self-administered questionnaire to screen the risk of non-adherence to PRP among the patients with chronic obstructive pulmonary disease. APRQ comprises of 6 main constructs such as disease management behaviour, perceived treatment benefits, emotional factors, perceived severity of disease, barriers towards treatment and coping attitude.
    MATERIALS AND METHODS: This was a preliminary validity study carried out in the physiotherapy department and respiratory clinic in an university teaching hospital. A total of 109 patients with average age of 58.8 ± 1 year participated in the study. The inclusion criteria for subjects were: patients diagnosed with chronic obstructive pulmonary diseases (COPD) (Stage II and III). Exclusion criteria include those COPD patients with mental problems and disabled patients. The tool was developed based on thematic analysis and in-depth interview with focus group and literature search on the factors that lead to non-adherence among the PRP's participants. Principal component analysis was carried out to examine the construct validity and content validity of APRQ.
    RESULTS: A total of 20 items were created under 6 constructs. However, 2 items (smoking and hospital admission) were eliminated due to poor correlations. Thus, the final version of APRQ was developed and validated with 18 items. Reliability was measured using internal consistency and achieved Cronbach's Alpha of 0.762.
    CONCLUSIONS: The findings from this preliminary study supports that APRQ may be a valid and reliable tool to screen adherence towards PRP among chronic lung disease patients.
    Study site: Respiratory clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
  16. Special tinted contact lens on colour-defects
    Mutilab HA, Sharanjeet-Kaur, Keu LK, Choo PF
    Clin Ter, 2012;163(3):199-204.
    PMID: 22964691
    PURPOSE: The objective of this study was to determine the visual function of colour-deficient subjects when wearing special red tint contact lenses.
    MATERIALS AND METHODS: A total of 17 subjects with congenital colour vision deficiency (14 deutans and 3 protans), voluntarily participated in this study. The average age for the subjects was 23.00 ± 4.06 years old. Visual functions tested were visual acuity (LogMAR), contrast sensitivity (FACT Chart) and stereopsis (TNO and Howard Dolman tests). Two types of special red tint lenses were used in this study; Type I (light red) and Type II (dark red).
    RESULTS: The protans and deutans showed no significant changes in visual acuity and contrast sensitivity when wearing either type of contact lens. Stereopsis testing using the Horward-Dolman test gave no significant changes but significant differences were seen using the TNO test. Stereopsis using the TNO test was significantly poorer with the red tinted contact lenses compared to without for both protons and deutans. Testing binocularly with Ishihara plates showed that 88% (n=15) of patients passed the test with Type I and Type II contact lenses. When D15 test was done, 3 patients (17.6%) were 'normal' when using the Type I contact lenses and 2 patients (11.8%) were 'normal' when using the Type II contact lenses. However, with FM100Hue test, most patients showed deutan responses. Total error scores (TES) were found to be higher with Type I and Type II contact lenses compared to without.
    CONCLUSIONS: The Type I and II special tinted contact lens used in this study did not cause a reduction of visual acuity and contrast sensitivity for the colour defects. Stereopsis was also not reduced with the Type I and Type II contact lenses for the colour defects except when tested with the TNO test. Colour vision defects became difficult to detect using the Ishihara plates but FM100Hue test did not show any improvement with the Type I and Type II contact lenses.
  17. The patients' understanding on the status and role of anaesthesiologists
    Budiman M, Izaham A, Abdul Manap N, Zainudin K, Kamaruzaman E, Masdar A, et al.
    Clin Ter, 2015 Nov-Dec;166(6):227-35.
    PMID: 26794808 DOI: 10.7417/CT.2015.1892
    OBJECTIVES: To evaluate patients' understanding on the status and role of anaesthesiologists.
    MATERIALS AND METHODS: This was a prospective, questionnaire-based cross-sectional study. The interview had three segments which questioned on (i) patients' knowledge of the qualification, training and role of anaesthesiologists, (ii) attitude of patients towards anaesthesia and anaesthesiologists and (iii) the demographic data of patients.
    RESULTS: Of 384 patients interviewed, 59.4% had prior anaesthesia experience. Most patients (95.6%) knew that anaesthesiologists were medical doctors, but only 27.1% knew the duration of training required to attain this specialist qualification. Patients' awareness of the various anaesthetic responsibilities was 12.2% in managing labour pain, 25.5% in intensive care units, 49.2% in chronic pain and 99.5% in postoperative pain management. During surgery, 73.7% of patients knew that anaesthesiologists were monitoring their vital signs, but only 42.2% thought anaesthesiologists also treated medical problems intraoperatively. Most patients (95.1%) would like to meet their anaesthesiologists prior to the operation and 97.7% want them to inform all possible anaesthesia complications.
    CONCLUSIONS: Our patients' understanding and awareness of the status and roles of anaesthesiologists are still limited and variable. This can be further improved with patient interaction and public education.
    KEYWORDS: Anaesthesiologist; Attitudes; Patient’s knowledge; Patient’s perception; Survey
  18. Transarterial angioembolization versus surgery after failed endoscopic therapy for non-variceal upper gastrointestinal bleeding
    Jailani RF, Kosai NR, Yaacob NY, Jarmin R, Sutton P, Harunarrashid H, et al.
    Clin Ter, 2014;165(6):294-8.
    PMID: 25524184 DOI: 10.7417/CT.2014.1771
    BACKGROUND AND OBJECTIVE: To compare the outcome of transarterial angioembolization (TAE) and surgery with endoscopically unmanageable non-variceal hemorrhage of the upper gastrointestinal tract.

    MATERIALS AND METHODS: A case note review of all patients treated for non-variceal upper gastrointestinal bleeding from January 2006 till January 2012 was performed.

    RESULTS: Fifty-four of 667 patients with non-variceal bleeding did not respond to endoscopic treatment. Nine of the 54 patients had incomplete data, leaving 45 patients in the study; 24 had angiography and another 21 had surgery. The two groups were broadly similar in terms of relevant clinical variables. Nineteen of 24 having angiography had embolisation. Re-bleeding recurred in 8 patients (33%) in the TAE group and 6 patients (28.6%) in the surgery group (p = 0.28). There was no statistically significant difference in post procedural complications (81% vs 62.5%, p = 0.17), 30-day mortality (33% vs 29.1%, p = 0.17 ) units of blood transfused (12.24 vs 8.92, p = 0.177) and mean hospital stay (30.7 vs 22.9 days, p = 0.281) observed in patients undergoing surgery as compared to TAE.

    CONCLUSIONS: TAE and surgery have similar outcomes in patients with endoscopically unmanageable non-variceal upper gastrointestinal haemorrhage.
  19. Involvement of liver in diabetes mellitus: herbal remedies
    Thent ZC, Das S
    Clin Ter, 2014;165(4):223-30.
    PMID: 25203338 DOI: 10.7417/CT.2014.1738
    Liver disease is considered as one of the major complications in oxidative stress disorders like diabetes mellitus (DM). DM presents with deterioration in carbohydrate metabolism which is characterized with chronic hyperglycemia. The organ which involves in glucose or carbohydrate metabolism and is most likely to be affected is the liver. Deterioration in liver architecture and metabolism in DM, are considered as common findings. In the present review both biochemical and histological changes occurring in diabetic liver are conferred in detail. To counteract the oxidative stress disorders and its untoward complications, antioxidant or herbs have emerged as alternative medicine. The present review focuses on several herbs with antioxidant properties towards diabetic liver disease such as Liquorice, Pelargonium gravenolens, Momordica charantia, Propolis from bee hives, Dihar, Curcuma Longa, Tinospora cordifolia, Kangen-karyu, Parsley, Chard, Green tea Catechins and Piper sarmentosum (P.s). The herbs or the compounds present in herbs have potential to improve the liver metabolism and maintain the integrity of liver tissue in DM. The review also opens the door for effective use of herbal products for complications involved in the diabetic liver disease.
  20. Misdiagnosed infected aneurysm presenting as pyrexia of unknown origin (PUO)
    Abdikarim M, Shahari S, Idris MA, Hanafiah H, Kosai NR, Das S
    Clin Ter, 2014;165(4):199-201.
    PMID: 25203333 DOI: 10.7417/CT.2014.1733
    Infected aneurysm is a life threatening clinical condition that is associated with significant morbidity and mortality. Early detection is essential for a rapid and efficacious initial treatment for better prognosis. Since the introduction of antibiotic therapy and concomitant decline of endocarditis, true mycotic aneurysms are rarely seen. The usual treatment consists of antibiotics along with aggressive surgical debridement of the infected tissue and vascular reconstruction, if needed. We here describe an infected aneurysm presenting as pyrexia of unknown origin and discuss the clinical features and challenges encountered in the treatment.
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