Introduction: To review the gestational age at diagnosis, method of diagnosis, pregnancy outcome and
maternal complications of prenatally diagnosed lethal foetal anomalies. Methods: Retrospective review of 25
women who had aborted or delivered foetuses with lethal anomalies in a tertiary hospital in 2011 based on
patient medical records. Results: There were a total of 10,088 deliveries, in which 25 (0.24%) women were
found to have conceived foetuses with lethal anomalies. All of them were diagnosed by prenatal ultrasound
and only 7 (28.0%) had both prenatal ultrasound and genetic study done. The women’s mean age was 29.9
years old. The mean gestational age at diagnosis of lethal foetal anomalies was 25.5 weeks (SD=12.5) and
mean gestational age at termination of pregnancy (TOP) or delivery was 28.5 weeks (SD=12.5). Seven (28%)
women had early counseling and TOP at the gestation of < 22 weeks. Beyond 22 weeks of gestation, eight
(32%) women had TOP and ten (40%) women had spontaneous delivery. Twenty (80%) women delivered or
aborted vaginally, three (12%) women with assisted breech delivery and two (8%) women with abdominal
delivery which were performed due to transverse foetal lie in labour and a failed induction, leading to
emergency hysterotomy complicated by hysterectomy due to intraoperative finding of ruptured uterus.
Overall, the associated post-partum adverse events included post-partum haemorrhage (12%), retained
placenta (12%), blood transfusion (8%), uterine rupture (4%) and endometritis (4%). Mean duration of hospital
stay was 6.6 days (SD 3.7 days). Conclusion: Late diagnosis of lethal foetal anomalies leads to various
maternal morbidities, in this case series , which could have been prevented if they were diagnosed and
terminated at early trimester. A new direction is needed in our local practice.
Introduction: Gastrointestinal stromal tumour (GIST) is relatively rare. The clinical behaviour of GIST ranges
from benign to frank sarcoma. The diagnosis is established through histopathological examination and
immunohistochemistry profile. In Malaysia, the number of publications related to GIST is relatively rare. This
study was therefore conducted to examine the demographic, histopathological and immunohistochemical
features of GIST cases diagnosed in the Department of Pathology, Hospital Tengku Ampuan Afzan, Kuantan,
Pahang from 2009 until 2014. Methods: Past histopathological records were reviewed. Demographic and
histopathological and immunohistochemical data of patients diagnosed were collected. Results: There were
28 cases (14 males and 14 females) diagnosed as GIST. Mean age was 56.4 years, and the majority were
above 40 years of age (85.7%). Stomach was the most common location (42.9%), followed by small intestine
(28.6%). In 23 cases (82%), the tumours exhibited spindle cell morphology, while epithelioid cell and mixed
cell types were seen in 3 cases (11%) and 2 cases (7%), respectively. Five cases were categorised as very low
risk to low risk behaviour, while 18 cases were intermediate to high. None of the histological parameters
analysed which include tumour morphology, necrosis, haemorrhage, nuclear atypia and mean number of
mitoses showed significance difference between the different risk behaviour groups. Positivity with KIT
(CD117), considered to be the defining immunohistochemistry feature, was negative in 2 cases. Conclusion:
Although this study is a retrospective study, the findings contribute to the knowledge on GISTS in Malaysia.
Future research related to GISTs in Malaysia should focus on molecular analyses for KIT and PDGFRA
mutations for diagnostic confirmation especially in KIT-negative cases and also for the purpose of
therapeutic response correlations.
Individuals with Diabetes Mellitus (DM) are at increased risk for developing
diabetic ocular complications. This study was carried out to determine factors
influencing eye screening among Diabetes Mellitus patients. The descriptive findings of
participants’ sociodemographic data will be discussed. (Copied from article).
Introduction: Abdominal obesity and inflammation are two independent risk factors for cardiovascular disease. However, the inter-relationship between these two factors among Malay population is fragmented. The purpose of this study is to determine the association between waist circumference as a measure of abdominal obesity and high-sensitivity C-reactive protein as an indicator of inflammation status among Malay obese adults in Kuantan, Pahang. Materials and Methods: Ninety-three apparently healthy obese adults (BMI between 27.5 and 39.9 kg/m2 ) aged between 20 to 62 years old were recruited in this study (68% men and 32% women). Circumference tape was used to measure the waist circumference and fasting venous blood was obtained to determine the high-sensitivity C-reactive protein level. Results: On average, the waist circumference of obese men and women was 103 cm (SD = 8.7) and 94 cm (SD = 7.0), respectively. The median (IQR) of the hs-CRP level of the study participant was 3.80 mg/L (1.5, 10.1). The Kendall’s Tau correlation reveals that there is a significant positive linear correlation between waist circumference and hs -CRP level in obese men (r (30) = 0.355, p = 0.006) and women (r (63) = 0.177, p = 0.043). Conclusion: There is a significant inter-relationship between waist circumference and hs-CRP level among apparently healthy obese adults in Kuantan, Pahang. This study suggests that assessment of hs-CRP level is beneficial to predict the risk for future cardiovascular disease event and facilitate the management of obesity in this population. A prospective clinical study is recommended to confirm the findings.
Background: Thyroid swelling or goitre is a common condition, either asymptomatic or symptomatic. The
diagnosis is usually established by ultrasound or fine needle aspiration cytology (FNAC) as a gold standard.
The sensitivity of the test is inversely related to increasing size of the nodule. The objective of this study is
to evaluate the accuracy of FNAC especially in cases of large goitre.
Material and methods: This is a
retrospective study on patients who underwent thyroidectomy between January 2000 to December 2007 for
solitary or dominant nodular goitre. The analysis was made only on those patients with complete data on
FNAC and histology.
Result: There were 235 patients, but only 161 patients were analysed after excluding
the suspicious and inadequate sample. The patients’ mean age was 42.1 year old (21 to 60). The size of the
thyroid nodule ranged from 2.1 to 5.0 cm (mean = 3.9 cm). The overall sensitivity was 67.4% and the overall
accuracy was 86.3%. The accuracy of FNAC according to the sizes above and below the value were as
follows; 2 cm (72.2% vs. 88.1%); 3 cm (88.0% vs. 87.4%) ; 4 cm (86.6% vs. 84.4%) ; 5 cm (87.3% vs. 78.8%).
This was most obvious in the sensitivity of the FNA which also showed reducing trend as the nodules
increased in size.
Conclusion: FNAC is an essential diagnostic tool in the management of nodular goitre.
Our study showed that the accuracy of FNAC decreased as the size of the nodule getting bigger. Cautious
approach should be taken in the management of large goitre and decision should not be based only on the
result of FNAC.
Acute appendicitis is the most common extra-uterine surgical emergency encountered during pregnancy, but an accurate diagnosis is still an enigma. Anatomical shifting of the appendix by the enlarging uterus makes the clinical and sonographic diagnosis difficult. Prompt diagnosis and treatment are essential to prevent perforation, which increases the risk of fetal and maternal death. Surgical intervention, either by an open laparotomy or laparoscopy is the most appropriate treatment for appendicitis. This article reviews the epidemiology, clinical diagnosis, investigation, complications and treatment of acute appendicitis in pregnancy.
Peripheral, predominantly motor polyneuropathy is associated with a plethora of possible aetiologies and the investigative procedures to rule them out are extensive. A 31 year old lady presented with progressive lower limb weakness over a period of 2 years. Examination revealed symmetrical weakness (3+/5) of all distal muscle groups in the lower limbs with absent ankle jerk. There was no sensory loss. The nerve conduction study revealed a predominantly axonal motor neuropathy. Cerebrospinal fluid examination and other investigations to rule out potential causes of predominantly motor peripheral neuropathy were normal. The only positive findings were multiple qualitative assays for porphobilinogen in her urine.
This case report describes a rigid bronchoscopy-assisted placement of a silicone airway Y-stent in a patient who developed tracheobronchomalacia following repeated dilatations for post-tuberculous airway stenosis. This is the first report of an airway Y-stent insertion in Malaysia.
Introduction: The goal of the present study was to examine the effect of alcohol consumption on sperm count and motility and the morphological changes in the seminiferous tubules of parent mice and their offspring. Methods: Animals were divided into two groups, Group 1 (alcohol group) of twelve male and twelve female mice, were given a daily dose of (3 g/kg body weight as 25%, v/v) ethanol by gastric gavage for four and eight weeks. Group 2 (control group) also of twelve male and twelve female mice; received normal access of food and water. After four weeks of treatment, the males and females in each group were allowed to mate, and ethanol treatment continued for up to another four weeks. Twelve male offspring from group 1 and twelve male offspring from group 2 were selected randomly and allowed to become mature. Male parent mice were killed at the 4th and 8th weeks of treatment, and their male offsprings were killed when they reached maturity age. Results: Physiological examination of the sperm solution showed that there was a significant decrease in sperm count and motility after 4 and 8 weeks of ethanol treatment in parent male mice, but this decrease was not significant in their adult offspring. Furthermore, histological investigations indicated testicular lesions in the parent male mice and their adult male offspring. Conclusion: Alcohol abuse has deleterious effects on the testes structure and on the sperm count and motility of the epididymal spermatozoa of both parent mice and their offspring.
Allah (s.w.t) has created innumerable distinct creatures and mentioned to us about their special qualities through His revelation. The Qur’an is the ultimate source of guidance for its followers for all aspects of life including science. If one is to study nature scientifically there are countless observable facts that are parallel to the teachings of Islam. One of these facts is echolocation found in bats and dolphins. These animals generate ultrasonic signals and detect the echoes reflected back to them to map out their environment and catch prey. Modern health sciences have already adopted this phenomenon in the form of ultrasound imaging for diagnosis of certain diseases. However, there is room for improvement in the overall performance of this technique. This article highlights the technological developments directly inspired by nature i.e., crawfish/crayfish and relates echolocation characteristics of bats and dolphins with basic principles of ultrasound imaging. In-depth studies on the echolocation properties of these creatures can lead to further improvement in the current ultrasound imaging technique. Such as; the construction of a transducer which simultaneously generates multi-frequency ultrasound signals and development of new interpreting software. Moreover, reading verses of the Holy Qur’an heartily and enthusiastically will lead to the development of innovative ideas that can be translated into reality and applied for the betterment of humankind.
Vancomycin bead is an important ancillary treatment for osteomyelitis caused by methicillin-resistant Staphylococcus aureus (MRSA). However, red-man syndrome, which can be a life-threatening complication of vancomycin, may occur from the use of vancomycin beads albeit rarely. We report our first case of red-man syndrome caused by vancomycin bead's insertion for chronic osteomyelitis. Symptomatic treatment was not
effective and removal of the vancomycin beads seems to be the best treatment for this condition.
Appendicitis within an Amyand's hernia is rare; when it occurs it is often misdiagnosed as a strangulated inguinal hernia. Management of these cases needs to be individualized according to the presentation. In uncomplicated cases, we recommend concurrent appendectomy and darning repair of the hernia. We present such a case and review the related literature.
Pulmonary sequestration is defined as a segment of ç separated from the tracheobronchial tree and receiving its blood supply from a systemic artery rather than a pulmonary arterial branch. Classically, it has been described in two forms: (1) intralobar sequestration (ILS), in which the sequestrated part of lung lies within normal pulmonary visceral pleura, and (2) extralobar sequestration (ELS), in which the abnormal segment of lung is completely separate and enclosed in its own pleural investment. The term sequestration was coined by Pryce in 1946 to describe a disconnected bronchopulmonary mass or cyst with an anomalous systemic artery. Since this original description, terminology has become confusing as investigator has recognized many variants of sequestration not strictly meeting the original description. The spectrum now recognized as a continuum, with normal vessels supplying abnormal lung at one end and abnormal vessels supplying normal lung at the other end. Recently, we incidentally found an asymptomatic, intralobar pulmonary sequestration during CT pneumocolon.
A 72-year old Englishman was admitted with rapid deterioration in cognitive function, gait disturbance, and cerebellar signs and lapsed into a coma within one week of admission to the hospital. He had long-standing hypertension and hypercholesterolaemia, for which he was on regular medication. He had suffered recurrent episodes of stroke between September 1997 and May 2001. Three months prior to presentation, he became forgetful and generally mentally slow, affecting his daily activities. He was also noted to have fluctuations in his conscious level, associated with myoclonic jerks of the limbs. The brain MRI revealed hyperintense lesions on T2- weighted images in the periventricular region, left corona radiata, centrum semiovale, pons, midbrain and right thalamus. The electroencephalograph revealed periodic sharp wave complexes, strongly suggestive of Creutzfeldt-Jakob disease. However, we were not able to get a tissue diagnosis or send the cerebrospinal fluid for protein 14-3-3.
Paragangliomas are uncommon tumors arising from the neuroendocrine elements (chief cells) of the paraganglia and symmetrically distributed along the aorta in close association with the sympathetic chain. Although functional tumors are easier to diagnose due to the clinical fi ndings caused by excess secretion of catecholamines and an elevation of the urinary catecholamine levels, however the diagnosis of nonfunctioning paraganglioma of the retroperitoneum is diffi cult and only few cases have been made before exploratory laparotomy. Although our patient was initially planned and operated by our gynaecological team, the incidental findings had to involve the general surgeons. She is fortunate that the tumour did not show any features of malignancy nor metastasis, however a long time follow up is needed in case of any possible recurrence.
Endometrial stromal sarcoma is a rare tumour of the uterus. We reported a case of a young lady with endometrial stromal sarcoma. She became pregnant while having the disease and delivered a healthy baby, her sixth, without any complication. A total abdominal hysterectomy with bilateral oopherectomy was performed subsequently. She refused any added treatment after the operation. To date, she is free of any recurrence.
Patient with thyroid mass rarely presents in emergency situation. It is because the nature of the mass is that it usually increases slowly in size. Thus, any surgical intervention can be planned electively. The most common condition that necessitates urgent intervention, is upper airway compromise due to sudden rapid increase in size of the swelling. This can be due to intralesional bleeding or superimposed infection on the enlarged gland. We report a case of urgent completion thyroidectomy performed to a patient with fungating recurrent papillary carcinoma who present with bleeding from the mass externally.
Introduction: The objectives of this study were to determine the prevalence and the pattern of hypodontia among orthodontic patients in Klinik Pergigian Jalan Sultan Mahmud, Kuala Terengganu.
Materials and Methods: This was a retrospective study where 351 orthodontic patients records (comprises of 104 males and 247 females), were reviewed. The records were evaluated by a trained dental officer between October 2016 and June 2017. The Chi-square and Fisher's Exact Tests were carried out for statistical analysis.
Results: The prevalence of hypodontia was 10.8%. Thirty-eight (38) patients were found to have at least a single missing tooth. A significant difference was found between males and females having hypodontia (p = 0.048). No significant difference was found for hypodontia patients by races (p = 0.829). The maxillary lateral incisor was the most frequently missing tooth followed by mandibular second premolar and mandibular lateral incisor. Hypodontia cases observed, tended to be more likely occurred in the upper left arch compared to the lower arch. The majority of hypodontia patients had a single missing tooth, but rarely more than 3 missing teeth. Hypodontia patients had mainly Class III malocclusion, however no statistically significant difference was found (p = 0.081).
Conclusion(s): The prevalence of hypodontia of this study was within the range of what is being reported in the literature and showed gender significant. In this sample, hypodontia mainly involved maxillary lateral incisors; more prevalent in the upper arch; and mostly observed in patients with Class III malocclusion. Early detection and accurate diagnosis are essential. Therefore, alternative treatment modalities can be well planned under multidisciplinary team approach in restoring the aesthetic and function.
KEYWORDS: referral letter
The timing of ABG procedure in a cleft patient is crucial to provide room and bony
support for the eruption of canine. However, there seems to be a delay in execution of this
procedure in certain centres. Material and Methods: Sample consists of records of cleft patients
treated from 2000-2016. The date and age for commencement of active orthodontic treatment,
date referred for ABG and date ABG done were retrieved. The centres that conducted these
surgeries identified. (Copied from article).
The Medical imaging service in Malaysia is expanding. The presence of
imaging technologies needs to be supported by homegrown research to optimize their
use. This study investigated the contribution of researches by Malaysian practitioners to
the field of Medical imaging in the Malaysian Citation index (MyCite) database. (Copied from article).