Displaying publications 21 - 40 of 159 in total

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  1. An interesting case of isolated pancreatic teratoma: lessons to learn
    Razman J, Azlanudin A, Eyad AJ, Zahiah M, Das S
    Clin Ter, 2012 Nov;163(6):495-7.
    PMID: 23306744
    Mature cystic teratomas of the pancreas are extremely rare tumours encountered in day-to-day clinical practice. Only few cases have been reported to date involving all age groups. The management, diagnosis and evaluation of this tumor are questionable, with definitive diagnosis taking place intra-operatively. We hereby report the case in a 30 year-old-male who presented with newly diagnosed diabetes mellitus and during the follow up he was noted to have elevated liver enzymes clinically, he was asymptomatic. The computerized tomography revealed a retropancreatic mass and pushing the mesenteric veins anteriorly. The mass was hypodense in nature and there was presence of calcification. Although the patient was asymptomatic, the decision for resecting the mass was made in view of the size and possibility of malignancy. In conclusion, considering the size and approximity of the mass to the pancreas, Whipple procedure's is the most appropriate approach although the histological diagnosis has not been established preoperatively.
  2. An unexpected case of primary peritoneal carcinoma
    Nur-Syahrina R, Siti-Aishah MA, Swaminathan M, Ng PH, Ismail S, Syazarina SO, et al.
    Clin Ter, 2010;161(3):261-3.
    PMID: 20589359
    Primary peritoneal carcinoma (PPC) is a rare tumor that is histologically and immunohistochemically indistinguishable from epithelial ovarian carcinoma. The diagnosis is usually made after excluding gross ovarian involvement or the ovarian involvement is only confined to the surface. A 68-year-old lady presented with right iliac fossa pain and increasing CA125. The CT scan showed bilateral pelvic adnexal masses with peritoneal deposits within the right side of abdomen. She was initially diagnosed as carcinomatosis peritonei from the omental cake removed after exploratory surgery. She was managed as advanced ovarian tumor with peritoneal metastasis and was then administered six cycles of chemotherapy. Surgical intervention included debulking surgery consisting of total abdominal hysterectomy, bilateral salpingooophorectomy and omentectomy and also with right hemicolectomy. The histopathological findings were of primary peritoneal serous carcinoma with only minimal involvement of the serosal surface of the right ovarian capsule. No microscopic invasion into underlying ovarian cortex and stroma was observed. Multiple tumor deposits were also seen over the right paratubal and paraovarian tissue, both parametrium as well as serosal surface of the terminal ileum and periappendicular tissue. Immunohistochemically, the malignant cells were positive to CA125, focally positive to CK7 and negative to CD20 and Calretinin. PPC is one of important differential diagnosis which needs to be considered in cases of advanced ovarian tumor, although the former can only be ascertained after excluding the ovarian involvement microscopically.
  3. An unique case of thoracic endovascular aortic repair (TEVAR) graft infection with Streptococcus viridans
    Zubaidah NH, Azim MI, Osama MH, Harunarashid H, Das S
    Clin Ter, 2012;163(1):27-9.
    PMID: 22362230
    The incidence of infection following TEVAR is low. To the best of our knowledge, this is the first case report of post thoracic endovascular aortic repair (TEVAR) with Streptococcus viridans graft infection. A 54-year-old male underwent TEVAR for dissecting thoracic aneurysm with spinal ischaemia. He had an eventful recovery with prolonged period of stay in intensive care unit. Three months later, he presented with persistent chest discomfort and fever. Computed tomography (CT) of the thorax revealed evidence of graft infection and the blood culture grew Streptococcus viridans. The rarity of TEVAR graft infection due to Streptococcus viridans and its management are being discussed.
  4. 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.
  5. An unusual cause of a penetrating injury to the anterior urethra: a thorny situation
    Tan GH, Ho CC, Bahadzor B, Praveen S, Goh EH, Afdzillah AR, et al.
    Clin Ter, 2013;164(1):35-7.
    PMID: 23455741 DOI: 10.7417/T.2013.1509
    Concurrent penetrating injury to the male external genitalia and the anterior urethra is uncommon. This case illustrates an unusual cause of such an injury, and its subsequent management and outcome. A 69-year-old man had his scrotum and anterior urethra pierced by a long thorn when he fell in his farm. He presented with urine leakage from the scrotal wound each time he micturated. Cystoscopic examination confirmed the cause and extent of the injury, and also facilitated the extraction of the thorn. The injury was allowed time to heal by urinary diversion with a urinary catheter. There were no stricture or fistula formations and the patient remained symptom-free at 3 months follow-up. Careful cystoscopic examination was both diagnostic and therapeutic in this case. A conservative approach is a feasible option in the management of selected cases of penetrating anterior urethral injury.
  6. Anhedonia among patients with Major Depressive Disorder: A comparison between patients on escitalopram and healthy controls
    Ng CG, Wong SK, Loh HS, Yee A
    Clin Ter, 2014;165(6):e384-90.
    PMID: 25524191 DOI: 10.7417/CT.2014.1778
    BACKGROUND AND AIMS: Escitalopram has widely been recognized as one of the most frequently used antidepressants, with superior tolerability and great efficacy in preventing major depressive disorder (MDD) relapse and recurrence. However, anhedonia, which is a core symptom of MDD, remains difficult to treat. This study investigates the hedonic levels of MDD patients treated with Escitalopram.

    MATERIALS AND METHODS: A total of 108 participants, 26 of whom with MDD on Escitalopram, were recruited in this cross sectional study. They were evaluated using the Snaith-Hamilton Pleasure Scale (SHAPS) and Beck Depression Inventory (BDI) questionnaires to assess their hedonic state, general mental health condition and level of depression.

    RESULTS: Our study shows that most items in the SHAPS scores are significantly different between MDD patients on Escitalopram and the controls.

    CONCLUSIONS: The hedonic capacity remains different between the two groups despite patients with MDD are put on Escitalopram treatment. Escitalopram fails to alleviate the hedonic state of MDD patients. Antidepressants that improve both depressive symptoms and hedonic states should be considered when treating MDD patients in clinical settings.
  7. 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.
  8. Fulltext Anthropometric analysis of mandible: an important step for sex determination
    Alias A, Ibrahim A, Abu Bakar SN, Swarhib Shafie M, Das S, Abdullah N, et al.
    Clin Ter, 2018 11 6;169(5):e217-e223.
    PMID: 30393808 DOI: 10.7417/CT.2018.2082
    INTRODUCTION: The first step in the forensic identification is sex determination followed by age and stature estimation, as both are sex-dependent. The mandible is the largest, strongest and most durable bone in the face. Mandible is important for sex confirmation in absence of a complete pelvis and skull.

    AIM: The aim of the present study was to determine sex of human mandible from morphology, morphometric measurements as well as discriminant function analysis from the CT scan.

    MATERIALS AND METHODS: The present retrospective study comprised 79 subjects (48 males, 31 females), with age group between 18 and 74 years, and were obtained from the post mortem computed tomography data in the Hospital Kuala Lumpur. The parameters were divided into three morphologic and nine morphometric parameters, which were measured by using Osirix MD Software 3D Volume Rendering.

    RESULTS: The Chi-square test showed that men were significantly association with square-shaped chin (92%), prominent muscle marking (85%) and everted gonial glare, whereas women had pointed chin (84%), less prominent muscle marking (90%) and inverted gonial glare (80%). All parameter measurements showed significantly greater values in males than in females by independent t-test (p< 0.01). By discriminant analysis, the classification accuracy was 78.5%, the sensitivity was 79.2% and the specificity was 77.4%. The discriminant function equation was formulated based on bigonial breath and condylar height, which were the best predictors.

    CONCLUSION: In conclusion, the mandible could be distinguished according to the sex. The results of the study can be used for identification of damaged and/or unknown mandible in the Malaysian population.

  9. Anti-inflammatory effect of Curcuma longa (turmeric) on collagen-induced arthritis: an anatomico-radiological study
    Taty Anna K, Elvy Suhana MR, Das S, Faizah O, Hamzaini AH
    Clin Ter, 2011;162(3):201-7.
    PMID: 21717043
    Curcuma longa (CL) or turmeric is an Ayurvedic herb that has been traditionally used to treat inflammatory conditions like rheumatoid arthritis (RA). Collagen-induced arthritis (CIA) is a well established experimental auto-immune mediated polyarthritis in susceptible strains of rodents. The main aim of the study was to observe the inflammatory, macroscopic and radiological changes in the arthritic ankle joints of experimentally collagen-induced arthritis animals treated with or without CL extract.
  10. Antinuclear antibodies predict a higher number of pregnancy loss in unexplained recurrent pregnancy loss
    Sakthiswary R, Rajalingam S, Norazman MR, Hussein H
    Clin Ter, 2015;166(2):e98-101.
    PMID: 25945451 DOI: 10.7417/CT.2015.1827
    OBJECTIVE: The etiology of recurrent pregnancy loss (RPL) is unknown in a significant proportion of patients. Autoimmune processes have been implicated in the pathogenesis. The role of antinuclear antibody (ANA) in this context is largely undetermined. In an attempt to address the lack of evidence in this area, we explored the clinical significance of antinuclear antibody (ANA) in unexplained RPL.
    MATERIALS AND METHODS: We studied 68 patients with RPL and 60 healthy controls from September 2005 to May 2012. All subjects were tested for ANA by immunofluorescence testing, and a titer of 1: 80 and above was considered positive. We compared the pregnancy outcome between the ANA positive and ANA negative RPL cases.
    RESULTS: The incidence of ANA positivity among the cases (35.3%) was significantly higher than the controls (13.3%) (p=0.005). ANA positive cases showed significantly higher number of RPL (p=0.006) and lower number of successful pregnancies (p=0.013) compared to the ANA negative cases . The ANA titre had a significant association with the number of RPL (p<0.05, r=0.724) but not with the number of successful pregnancies (p=0.054).
    CONCLUSIONS: ANA positivity predicts a less favorable pregnancy outcome in RPL. Our findings suggest that the ANA titre is a useful positive predictor of the number of RPL. Hence, ANA test is a potential prognostic tool for this condition which merits further research.
  11. Antispermatogenic and antifertility effect of Pegaga (Centella asiatica L) on the testis of male Sprague-Dawley rats
    Yunianto I, Das S, Mat Noor M
    Clin Ter, 2010;161(3):235-9.
    PMID: 20589353
    Antifertility agents with safety and effectiveness in terms of minimum side effects have always been a subject of debate. Many studies have been conducted on plants to observe the antifertility effect, but majority of them were toxic. Pegaga or Centella asiatica L. is one of the popular herb traditionally consumed raw amongst people in Malaysia. The main objective of the present study was to investigate the effects of Centella asiatica L. extract on rat testis.
  12. Arterial embolization of a bleeding gastric Dieulafoy lesion: a case report
    Mohd Rizal MY, Kosai NR, Sutton PA, Rozman Z, Razman J, Harunarashid H, et al.
    Clin Ter, 2013;164(1):25-7.
    PMID: 23455738 DOI: 10.7417/T.2013.1506
    Dieulafoy's lesion is one of an unusual cause of upper gastrointestinal bleeding (U GIB). Endoscopic intervention has always been a preferred non-surgical method in treating UGIB including bleeding from Dieulafoy's lesion. Owing to recent advances in angiography, arterial embolization has become a popular alternative in non- variceal UGIB especially in cases with failed endoscopic treatment. However, managing bleeding Dieulafoy's with selective arterial embolization as the first line of treatment has not been exclusively practiced. We hereby, report a case of bleeding Dieulafoy lesion which had been primarily treated with arterial embolization.
  13. 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.
  14. Fulltext Association between nonalcoholic fatty liver disease and carotid intima-media thickness
    Vu H, Khanh Tuong TT, Hoang Lan N, Quoc Thang T, Bilgin K, Hoa T, et al.
    Clin Ter, 2023;174(1):42-47.
    PMID: 36655643 DOI: 10.7417/CT.2023.5007
    BACKGROUND: Many non-invasive methods have been studied for assessing the severity of fatty liver disease and carotid intima-media thickness (CIMT). However, the correlation between hepatic steatosis and CIMT has not been fully studied, either globally or in Vietnam. This study investigated the association between nonalcoholic fatty liver disease (NAFLD) and CIMT.

    METHODS: A cross-sectional study was performed on 125 patients at the Cardiology Department, the Emergency Interventional Cardiology Department, and the Internal Cardiology Clinic of Thong Nhat Hospital.

    RESULTS: Among the 125 patients in our study population, NAFLD was diagnosed in 56%, and the mean CIMT was 0.89 ± 0.48 mm. Normal CIMT was measured in 21% of patients, whereas 79% had an elevated CIMT. The NAFLD rates were significantly different between patients with normal and increased CIMT, at 26.9% and 69.6%, respectively (p = 0.001).

    CONCLUSIONS: Our study revealed a strong association between NAFLD and CIMT. NAFLD is currently considered a feature of metabolic syndrome, and an increase in the prevalence of NAFLD might result in an increase in the incidence of cardiovascular disease.

  15. Atypical (symplastic) leiomyoma of the uterus--a case report
    Siti-Aishah MA, Noriah O, Malini MN, Zainul-Rashid MR, Das S
    Clin Ter, 2011;162(5):447-50.
    PMID: 22041803
    A 30-year-old, nulliparous woman presented with a history of subfertility. On examination she was found to have uterine fibroid of 28 weeks size of gravid uterus and subsequently laporatomy myomectomy was performed. Multilobulated masses, with diameters ranging from 22 mm to 160 mm were found. Cut sections of the lobulated masses showed whitish whorled cut surface. One of the multilobulated masses had a cystic cavity, measuring 60x50x35 mm(3). Light microscopic findings of the mass with the cystic cavity showed a well-circumscribed cellular tumour composed of cells exhibiting moderate nuclear atypia which were enlarged, nuclei with prominent chromatin clumping and were distributed in areas. Some tumour cells showed large nuclear pseudoinclusions, multinucleated or multilobated tumour giant cells, smudging and few enlarged nucleoli. Mitotic activity was 4 MFs per 10 HPFs. Occasional cells with intracytoplasmic inclusions resembling rhabdoid - like features were seen. There were no atypical mitoses or tumour necroses were noted. Diagnosis of atypical leiomyoma or symplastic leiomyoma was made. Atypical or symplastic leiomyomas are rare in the region of Malaysia and the present case discusses its incidence in younger age, its morphological features along with diagnosis and clinical outcome.
  16. Fulltext Autogenous free fat graft combined with platelet-rich fibrin heals a refractory mandibular osteoradionecrosis
    Law B, Mohd Yunus SS, Ramli R
    Clin Ter, 2020 3 7;171(2):e110-e113.
    PMID: 32141481 DOI: 10.7417/CT.2020.2199
    Osteoradionecrosis (ORN) is a well-recognized, debilitating complication of radiotherapy for patients with head and neck cancer. There is no universally accepted treatment for ORN of the jawbones. We report on a case of refractory mandibular ORN treated by sequestrectomy of mandible and autogenous transplantation of fat graft combined with platelet-rich fibrin (PRF). Improved perfusion was observed using the laser Doppler flowmetry. This case highlights the use of autogenous free fat graft and PRF as an adjunct therapy to sequestrectomy in the management of ORN.
  17. Bilateral emphysematous pyelitis: a rare encounter in urology
    Tan C C K Ho GH, Bahadzor B, Praveen S, Goh EH, Syahril AS, Zulkifli MZ
    Clin Ter, 2013;164(4):319-21.
    PMID: 24045515 DOI: 10.7417/CT.2013.1580
    Gas-forming infection of the kidneys can affect either the parenchyma or the collecting system. They are known as emphysematous pyelonephritis (EPN) and emphysematous pyelitis (EP) respectively. Bilateral EPN is a fairly established entity and numerous articles about this condition have been published. However, much less is known about bilateral EP. We report a rare case of bilateral EP and a literature review of this disease. A 66-year-old woman with long-standing bilateral staghorn calculi presented with bilateral EP and severe sepsis. She was treated with antibiotics and bilateral double-J stents to drain the upper urinary tracts. She recovered after 1 month of intensive care and medical therapy. Percutaneous nephrolithotomy (PCNL) had been scheduled to treat her staghorn calculi. A literature search on MEDLINE and Google Scholar with the terms "bilateral emphysematous pyelitis" only found 1 case report in English and another 2 reports in the Korean language that discussed bilateral EP. The collective experience of these few cases, including the present case, suggests that bilateral EP runs a more benign course than bilateral EPN. It should be diagnosed as soon as possible with computed tomography (CT) scans of the renal system. Current evidence shows that can be treated successfully with timely antibiotics. Drainage of the collecting system either percutaneously or with placement of double-J stents might facilitate recovery.
  18. Calcium score of coronary artery stratifies the risk of obstructive coronary artery diseases
    Ibrahim O, Oteh M, Anwar IR, Che Hassan HH, Choor CK, Hamzaini AH, et al.
    Clin Ter, 2013;164(5):391-5.
    PMID: 24217823 DOI: 10.7417/CT.2013.1601
    Coronary heart disease is a major health problem in Malaysia with high morbidity and mortality. Common primary screening tool of cardiovascular risk stratification is exercise treadmill test (ETT). This communication is to determine the performance of coronary artery calcium score a new method to stratify the presence of obstructive coronary artery disease (CAD) in comparison to traditional ETT in patients having coronary artery diseases.
  19. 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.
  20. Changes in transversus abdominis muscle thickness after lumbo-pelvic core stabilization training among chronic low back pain individuals
    Leonard JH, Paungmali A, Sitilertpisan P, Pirunsan U, Uthaikhup S
    Clin Ter, 2015;166(5):e312-6.
    PMID: 26550815 DOI: 10.7417/T.2015.1884
    OBJECTIVE: Lumbo-pelvic core stabilization training (LPST) is one of the therapeutic exercises common in practice for rehabilitation of patients with chronic low back pain. This study was carried out to examine the therapeutic effects of LPST on the muscle thickness of transversus abdominis (TrA) at rest and during contraction among patients with chronic non-specific low back pain.
    MATERIALS AND METHODS: A total of 25 participants (7 males and 18 females) with chronic non-specific low back pain participated in a within-subject, repeated measures, double-blinded, placebo-controlled comparisons trial. The participants received three different types of experimental therapeutic training conditions which includes the lumbo-pelvic core stabilization training (LPST), the placebo treatment with passive cycling (PC) and a controlled intervention with rest (CI). The interventions were carried out by randomization with 48 hours between the sessions. The effectiveness of interventions was studied by measuring the changes in muscle thickness of TrA at rest and during contraction using a real time ultrasonography.
    RESULTS: Repeated measures ANOVA demonstrated that the LPST provided significant therapeutic benefits as measured by an increase in the muscle thickness of the TrA at rest (p<0.05) and during contraction (p<0.01). The percentage change of the muscle thickness observed during LPST was significantly higher (p<0.01) when compared to the other two experimental training conditions.
    CONCLUSIONS: The findings indicated that the LPST might provide therapeutic benefits by increasing the muscle thickness and function of TrA. Therefore, it is suggested that LPST technique should be considered as part of management program for treatment of low back pain.
    KEYWORDS: Back pain; Core stabilization; Lumbo-pelvic exercise; Rehabilitation; Transversus abdominis
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