MyMedR

Male ductal carcinoma in situ (DCIS): treatment strategies in this rare entity

Aznan MS, Razrim R, Affirul CA, Rohaizak M

Clin Ter, 2015;166(5):e327-9.

PMID: 26550818 DOI: 10.7417/T.2015.1887

Ductal carcinoma in situ (DCIS) in females is a recognized premalignant disease. However, its occurrence in males is rare. Articles describing this disease are scarce with documented occurrence is less than 7% worldwide. We report a case of 52 year-old gentleman presented with 6 months history of left breast lump. It was painless with no nipple discharge. Despite an inconclusive biopsy, lumpectomy was performed in view of the suspicion of malignant disease. Histopathology confirms DCIS. He underwent mastectomy and sentinel lymph nodes. Most treatment strategies are based on evidence on female breast malignancy and modifications are needed due to the different pathological pathway in male.

Effect of palm oil (Elaeis guineensis) tocotrienols on mesenteric adipose tissue deposition and the expression of 11β-hydroxysteroid dehydrogenase type 1 enzyme (11β-HSD1) in adrenalectomized rats treated with dexamethasone

Azwan K, Farihah HS, Fairus A, Elvy MR

Clin Ter, 2015;166(3):99-104.

PMID: 26152615 DOI: 10.7417/CT.2015.1837

A study was done to investigate the effect of palm oil (Elaeis guineensis) tocotrienols on (1) rats mesenteric adipose tissue deposition (2) and 11β-HSD1 enzyme expression in mesenteric adipocyte. There is a necessity to find an inhibitor for the 11β-HSD1 enzyme which enhances the proliferation of mesenteric adipocyte tissue therefore curbing the onset of metabolic syndrome.

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

Carotid revascularization in patient with asymptomatic unilateral carotid stenosis undergoing coronary bypass--a futile effort!

Chai FY, Ishamuddin IM, Hairulfaizi H, Joanna SM, Ramzisham AR

Clin Ter, 2012;163(2):125-7.

PMID: 22555827

The best management of asymptomatic carotid artery disease in patient who needs coronary bypass remains controversial. We report the neurological outcome of four patients with asymptomatic unilateral significant carotid artery disease who underwent conventional coronary bypass without carotid revascularization. Our review highlighted the risk of perioperative stroke is not increased despite carotid revascularization was not performed. Asymptomatic carotid artery disease is not the cause for cerebral infarct but soft aortic atheroma encountered during surgery is the main culprit.

Anomalous structures of the liver: an anatomical insight

Choy KW, Kogilavani S, Norshalizah M, Rani S, Aspalilah A, Farihah HS, et al.

Clin Ter, 2013 May-Jun;164(3):197-201.

PMID: 23868619 DOI: 10.7417/CT.2013.1549

Anomalous structures of the liver are incidentally detected during autopsies or during routine cadaveric dissection. The present study aimed to observe the abnormal shapes of quadrate lobe, accessory sulci and ligamentum teres of the liver.

Topographical anatomy of the profunda femoris artery and the femoral nerve: normal and abnormal relationships

Choy KW, Kogilavani S, Norshalizah M, Rani S, Aspalilah A, Hamzi H, et al.

Clin Ter, 2013;164(1):17-9.

PMID: 23455736 DOI: 10.7417/T.2013.1504

Femoral nerve (FN) is the largest branch of lumbar plexus. It lies lateral to femoral artery (FA) and it is located outside the femoral sheath. Profunda femoris artery (PFA) is a branch of the FA. The present study aimed to observe the topographical anatomy and relationship of the PFA and the FN.

Effect of Exercise on Pulmonary Function Tests in Obese Malaysian Patients

Christopher LK, Kosai NR, Reynu R, Levin KB, Taher MM, Sutton PA, et al.

Clin Ter, 2015;166(3):105-9.

PMID: 26152616 DOI: 10.7417/CT.2015.1838

Obesity has taken the 21st century by storm, posing negative effects on of the various facades of health, healthcare and global economy. With regards to pulmonary performance, numerous studies have proven the detrimental effects of obesity while reinstating the positive effects of weight loss on overall pulmonary function. However, effects of exercise on pulmonary function and correlation between changes in pulmonary function test with weight loss have yet to be described. We performed a prospective interventional study to determine the effects of regular exercise on Pulmonary Function Tests (PFT) and ascertain the relationship between weight loss and change in PFT in obese patients.

An atavastic belly of the flexor digitorum profundus with absence of tendon of flexor digitorum superficialis to the little finger: morphological and histological considerations

Das S, Norzana AG, Azian AL, Farihah HS, Faizah O

Clin Ter, 2011;162(6):555-7.

PMID: 22262329

In this case report, we report the absence of the fourth tendon of flexor digitorium superficialis (FDS) to the little finger with a concurrent anomalous muscular belly of flexor digitorum profundus (FDP) in the palm. The FDS originated from the medial epicondyle, divided into three tendons for the index, middle and ring fingers with the little finger devoid of any attachment. The FDP exhibited a muscular belly which passed deep to the flexor retinaculum (FR) and continued for another 4 cm thereby dividing into four slips for the index, middle, ring and little fingers. The presence of the muscular belly of the FDP lead us to think whether it was an adhesion between the tendons of the FDP, so we proceeded to histological analysis. The tissue was processed and stained with Hematoxylin and Eosin. Abundant longitudinal muscle fibers with peripherally situated nuclei confirmed it to be a skeletal muscle. Absence of the tendon of FDS to little finger may influence the flexion movement in the middle and proximal interphalangeal joints. Presence of anomalous muscle belly of FDP in the palm may mimic any soft tissue tumour, compress neurovascular structures or even pose difficulty while performing tendon transplant surgeries.

An unusual case of additional branches of median nerve innervating the corachobrachialis muscle and its clinical implications

Das S, Maatoq Sulaiman I, Hussan F, Haji Suhaimi F, Latiff AA, Othman F

Clin Ter, 2009;160(1):25-7.

PMID: 19290409

The flexor compartment muscles of the arm comprising of biceps brachii, brachialis and the coracobrachialis are innervated by the musculocutaneous nerve arising from the lateral cord of the brachial plexus. In the present study, we report a case of anomalous innervation of the corachobrachialis muscle on the left side of a 45-year-old male cadaver. The musculocutaneous nerve originated from the lateral cord, as usual and pierced the corachobrachialis muscle. The median nerve was formed by a contribution from both lateral and medial roots, both of which took origin from the lateral and medial cords, respectively. In addition to the usual musculocutaneous nerve which pierced the corachobrachialis muscle and innervated it, two more anomalous branches from the median nerve were observed to innervate the corachobrachialis. The anatomical knowledge of the variations of the innervations of the corachobrachialis muscle may be important not only for surgeons performing coracoid transfer but also for clinicians diagnosing nerve lesions.

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.

The preventive effect of physical activity on weight maintenance in overweight and obese women

Dashti S, Esfehani AJ, Leonard Joseph HJ

Clin Ter, 2014;165(3):155-61.

PMID: 24999570 DOI: 10.7417/CT.2014.1715

Prevalence of obesity has increased recently especially in women. Obesity is related to mortality due to non-communicable diseases and has become a public health issue. Among the two important factors to reduce weight calorie limitation alone is modestly effective in initial weight but can result in weight gain after primary weight reduction is common. Therefore adding physical activity to weight maintenance program can reduce weight gain rebound. The aim of this review article was to identify the preventive effect of physical activity on weight maintenance in overweight women. Articles were selected from PubMed database and screened for the relativity to the study objectives, using scoring systems. Eleven studies were found appropriate. No statistical test was done on the data except simple mean and some descriptive analyses. Physical activity is proved to have a significant effect in weight loss/maintenance both in induction and maintenance period. This effect was more significant in higher intensities. Sever intensity physical activity can be effective in weight maintenance in long term but the effect of moderate and light physical activity could not be evaluated due to lack of data.

A prospective cohort study on quality of life after endoscopic thoracic sympathectomy for primary hyperhidrosis

Dharmaraj B, Kosai NR, Gendeh H, Ramzisham AR, Das S

Clin Ter, 2016;167(3):67-71.

PMID: 27424505 DOI: 10.7417/CT.2016.1928

BACKGROUND: Hyperhidrosis is an excessive sweating disorder affecting quality of life. Endoscopic thoracic sympathectomy (ETS), introduced by Kux in 1951, is currently the gold standard surgical treatment for primary hyperhidrosis. 75% of patients with primary hyperhidrosis have seen improvement in quality of life within 30 days after surgery. Compensatory hyperhidrosis and pneumothorax (up to 75%) have been reported in patients after surgery. This study evaluates the functional status, self- esteem, compensatory hyperhidrosis and quality of life among patient with primary hyperhidrosis before and after undergoing ETS.
METHOD: Fifty (n=50) patients between the ages 18 to 30, with primary hyperhidrosis were recruited. Patients answered the quality of life questionnaire and Rosenberg self-esteem questionnaire prior to surgery and 30 days post surgery on follow up. Any post-operative complications were documented. Telephone interviews were held for patients who were unable to attend the clinics for follow-up.
RESULTS: Forty six patients (92%) had symptomatic relieve within 30 days of surgery. The incidence of compensatory sweating was 78% (39 patients), with 6 patients developing severe hyperhidrosis. Two patients who did not experience symptomatic relieve, developed compensatory hyperhidrosis. Pneumothorax was documented in 8 patients (16%), with 6 patients requiring chest tubes. Significant improvement in quality of life and self-esteem was seen among patients after surgery.
CONCLUSIONS: ETS has shown to significantly improve the quality of life and self-esteem of patients with primary hyperhidrosis within 30 days of surgery. However, the rate of compensatory hyperhidrosis still remains high (78%) which requires a long term evaluation.
KEYWORDS: Hyperhyrosis; Quality of life; Thoracoscopic Symphatectomy

Fulltext Susceptibility of Bacillus subtilis to Zinc Oxide Nanoparticles Treatment

Djearamane S, Sundaraji A, Eng PT, Liang SXT, Wong LS, Senthilkumar B

Clin Ter, 2023;174(1):61-66.

PMID: 36655646 DOI: 10.7417/CT.2023.2498

AIM: With the characteristics such as low toxicity, high total surface, ability to inhibit the growth of pathogenic microorganisms, zinc oxide nanoparticles (ZnO NPs), as one of the metallic nanoparticles, have been chosen as an antibacterial agent to treat various skin infections. The present study was aimed to determine the antibacterial potential of ZnO NPs on Bacillus subtilis, the Gram-positive bacterium that can cause skin and wound infections.

METHODS: B. subtilis was exposed to 5 to 150 μg/mL of ZnO NPs for 24 h. The parameters employed to evaluate the antimicrobial potential of ZnO NPs were the growth inhibitory effect on B. subtilis, the surface interaction of ZnO NPs on the bacterial cell wall, and also the morphological alterations in B. subtilis induced by ZnO NPs.

RESULTS: The results demonstrated a significant (p <0.05) inhibition of ZnO NPs on B. subtilis growth and it was in a dose-dependent manner for all the tested concentrations of ZnO NPs from 5 to 150 μg/mL at 24 h. Fourier transformed infrared (FTIR) spectrum confirmed the involvement of polysaccharides and polypeptides of bacterial cell wall in surface binding of ZnO NPs on bacteria. The scanning electron microscopy (SEM) was used to visualize the morphological changes, B. subtilis illustrated several surface alterations such as distortion of cell membrane, roughening of cell surface, aggregation and bending of cells, as well as, the cell rupture upon interacting with ZnO NPs for 24 h.

CONCLUSION: The results indicated the potential of ZnO NPs to be used as an antibacterial agent against B. subtilis. The findings of the present study might bring insights to incorporate ZnO NPs as an antibacterial agent in the topical applications against the infections caused by B. subtilis.

Targeting genes in insulin-associated signalling pathway, DNA damage, cell proliferation and cell differentiation pathways by tocotrienol-rich fraction in preventing cellular senescence of human diploid fibroblasts

Durani LW, Jaafar F, Tan JK, Tajul Arifin K, Mohd Yusof YA, Wan Ngah WZ, et al.

Clin Ter, 2016;166(6):e365-73.

PMID: 26794818 DOI: 10.7417/T.2015.1902

Tocotrienols have been known for their antioxidant properties besides their roles in cellular signalling, gene expression, immune response and apoptosis. This study aimed to determine the molecular mechanism of tocotrienol-rich fraction (TRF) in preventing cellular senescence of human diploid fibroblasts (HDFs) by targeting the genes in senescence-associated signalling pathways.

Piper sarmentosum is comparable to glycyrrhizic acid in reducing visceral fat deposition in adrenalectomised rats given dexamethasone

Fairus A, Ima Nirwana S, Elvy Suhana MR, Tan MH, Santhana R, Farihah HS

Clin Ter, 2013;164(1):5-10.

PMID: 23455734 DOI: 10.7417/CT.2013.1502

Visceral obesity may be due to the dysregulation of cortisol production or metabolism that lead to metabolic disease. In adipose tissue, the enzyme 11beta-hydroxysteroid dehydrogenase type 1 regulates cortisol metabolism (11beta-HSD1). A previous study showed an increase in the visceral fat deposition in adrenalectomised rats given intramuscular dexamethasone. Glycyrrhizic acid (GCA) has been shown to reduce fat deposition because it is a known potent inhibitor of the 11beta-HSD1 enzyme. Piper sarmentosum (PS) is an edible medicinal plant commonly used in Asia as traditional medicine for treating diabetes, hypertension and joint pains. In this study, we determined the effects of PS extract on the disposition and morphology of perirenal adipocytes of adrenalectomised rats given intramuscular dexamethasone.

Spinal arteriovenous malformation presenting with prolapsed intervertebral disc: a diagnostic dilemma

Farina MY, Harunarashid H, Faridzal F, Jegan T, Das S

Clin Ter, 2012 Nov;163(6):491-3.

PMID: 23306743

The availability of multiple investigating modalities should be utilized to arrive at the correct diagnosis of the spinal arteriovenous malformation (AVM). We hereby report the case of a 21-year-old, obese female, who presented with paraplegia and impaired bowel control two years after an episode of the fall. The Magnetic Resonance Imaging (MRI) of her spine not only revealed disc prolapse at T11-T12, but also tortuous dilated spinal veins and cord oedema. A diagnosis of a spinal arterio-venous fistula was confirmed after a spinal angiogram. The dilemma of treating the right pathology for the clinical signs and symptoms are being discussed.

A prospective randomised comparison of bipolar diathermy versus conventional dorsal slit technique for ritual circumcision: a Malaysian experience

Fariz MM, Tarmizi MN, Ainaini MH, Khairil AM, Faizal A, Sagap I

Clin Ter, 2011;162(6):543-5.

PMID: 22262325

BACKGROUND AND OBJECTIVES: Ritual circumcision is one of the most common surgical procedures performed in the developing world. Various technique for circumcision has been described to increase patient's safety and to decrease operating time. This study will look at comparing the conventional method of circumcision using scissors and ligatures with bipolar diathermy. To compare the incidence of bleeding and infection in patients who underwent circumcision between using the bipolar diathermy technique with conventional surgery (dorsal slit) technique for circumcision. The operative time between the two techniques were also recorded.
MATERIALS AND METHODS: A prospective, randomized study was conducted in all children undergoing ritual circumcision at Raja Perempuan Zainab II Hospital, Malaysia over a 1-year period. Data analysed were the operation time,postoperative bleeding rates and infection rates.
RESULTS: A total of 341 patients were included in the study. Randomization resulted in 183 patients in conventional surgery group and 158 patients in bipolar group. The incidence of bleeding were significantly better in the bipolar group compared to conventional group (3.1% vs 19.7%), (p<0.001). There was no significant difference in the infection rate (1.3% vs 2.7%) (p=0.457). Operative times were shorter in the bipolar diathermy group (Mean 8.2 minutes) compared to conventional group (Mean 15.3 minutes) (p<0.01).
CONCLUSION: Bipolar diathermy technique for circumcision is safe and quicker than the dorsal slit technique.

A preliminary study of reactive oxygen species activity within motile Boer buck sperm using confocal laser scanning microscope (CLSM)

Fatimah IS, Iswadi IM, Khairul O, Nurhazilah M, Fadzilah MS, Padzil AR, et al.

Clin Ter, 2010;161(2):125-8.

PMID: 20499025

There is an association between reactive oxygen species (ROS) and DNA damage to sperm. Researchers believe that ROS is always present at the sperm's head. The variation of ROS concentration within the area has an impact on the integrity of the DNA.

Adductor accessorius - an unusual supernumerary adductor muscle of thigh

Goel S, Arora J, Mehta V, Sharma M, Suri RK, Rath G, et al.

Clin Ter, 2015;166(3):114-7.

PMID: 26152618 DOI: 10.7417/CT.2015.1840

The knowledge of variant anatomy of medial compartment of thigh is extremely important in surgical procedures requiring obturator nerve block. The nerve block is also recommended for providing additional analgesia following major knee surgeries and for relieving painful adductor muscle spasm. The interfascial injection technique is commonly followed in ultrasound guided obturator nerve block. For this procedure it is imperative to identify the adductor muscles on sonography to inject the anesthetic solution in the intermuscular fascial planes. The presence of an additional muscle can prove useful in myocutaneous flap surgeries for reconstruction especially of perineum. We hereby report a case of such an anomalous supernumerary adductor muscle present between adductor brevis and proximal part of adductor magnus, in an adult Indian male cadaver, recorded during routine dissection in Department of Anatomy, Vardhman Mahavir Medical College and Safdarjung Hospital. The muscle was innervated by the posterior division of obturator nerve. The morphology, embryological basis and clinical aspects are also discussed.

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.

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