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  1. Lau SC, Azim E, Abdul Latiff Z, Syed Zakaria SZ, Wong SW, Wu LL, et al.
    Med J Malaysia, 2018 12;73(6):382-387.
    PMID: 30647208
    INTRODUCTION: A smooth transition of healthcare for young people with chronic illnesses from paediatric to adult healthcare services is important to ensure optimal outcome. At the moment, there are no standard guidelines to assess a patient's readiness to transfer care.

    METHODS: A cross-sectional study using a self-administered questionnaire, adapted from UNC (University of North Carolina) TRxANSITION self-assessment tool was conducted to evaluate patients' transition care readiness in paediatric haematology and paediatric diabetes clinic.

    RESULTS: A total of 80 patients (37 thalassaemia and 43 diabetes) with the mean age of 21.2 (SD±4.3) years, were recruited during the 3-month study period. Majority of the patients have basic knowledge regarding their medications, and were able to comply with their follow-up. The mean total score obtained by the respondents on this questionnaire was 15.3 (SD±3.59). Self-management skills and knowledge on disease were the two poorly scored section; with mean score of 3.78 (SD±1.38) and 4.28 (SD±1.20) respectively. Overall, only 21 (26.2%) respondents obtained high score (score above 75th percentile). Seventy-five percent of the respondents admitted that they were not ready for transfer to an adult healthcare service yet at the time of the study.

    CONCLUSION: We suggest that patients with high score should be prepared for transition to adult facility whereas those with a low score need to be identified to ensure provision of continuous education.
  2. Cheah IG, Choo WY
    Med J Malaysia, 2016 06;71(Suppl 1):87-99.
    PMID: 27801391 MyJurnal
    The aim of this review was to summarise published literature on child abuse and neglect and its consequences in Malaysia, to discuss the implications of the research findings and to identify gaps in the local literature on child abuse and neglect. Medical and social literature in the English language published between the year 2000 to 2015 were searched for, resulting in forty four papers to be reviewed inclusive of a few key papers in the earlier years to provide some background information. The literature shows that child abuse and neglect is an important impact factor on mental health outcomes, involvement in substance abuse and delinquency due to the slant of the research interest from social studies. At least 70% of perpetrators are known to the affected children according to school-based prevalence studies. Safety programs and rehabilitation outcome studies involve small cohort groups. Studies on childhood mortality from child abuse or neglect are very limited. Overall, there are a few comprehensive studies involving school children but overall available studies are too patchy in to advocate for resource allocation, change in statutory procedures or training requirements. More extensive studies looking at the complex interaction of social environment, parenting skills, societal attitudes and responses, resilience factors and child safety nets and statutory response and their impact on different types of abuse or neglect are required.
  3. Andy Ko TY, Chen LS, Pang IX, Ling HS, Wong TC, Sia Tonnii LL, et al.
    Med J Malaysia, 2021 03;76(2):125-130.
    PMID: 33742617
    INTRODUCTION: The global pandemic of Corona Virus Disease 2019 (COVID-19) has led to the re-purposing of medications, such as hydroxychloroquine and lopinavir-ritonavir in the treatment of the earlier phase of COVID-19 before the recognized benefit of steroids and antiviral. We aim to explore the corrected QT (QTc) interval and 'torsadogenic' potential of hydroxychloroquine and lopinavir-ritonavir utilising a combination of smartphone electrocardiogram and 12-lead electrocardiogram monitoring.

    MATERIALS AND METHODS: Between 16-April-2020 to 30-April- 2020, patients with suspected or confirmed for COVID-19 indicated for in-patient treatment with hydroxychloroquine with or without lopinavir-ritonavir to the Sarawak General Hospital were monitored with KardiaMobile smartphone electrocardiogram (AliveCor®, Mountain View, CA) or standard 12-lead electrocardiogram. The baseline and serial QTc intervals were monitored till the last dose of medications or until the normalization of the QTc interval.

    RESULTS: Thirty patients were treated with hydroxychloroquine, and 20 (66.7%) patients received a combination of hydroxychloroquine and lopinavir-ritonavir therapy. The maximum QTc interval was significantly prolonged compared to baseline (434.6±28.2msec vs. 458.6±47.1msec, p=0.001). The maximum QTc interval (456.1±45.7msec vs. 464.6±45.2msec, p=0.635) and the delta QTc (32.6±38.5msec vs. 26.3±35.8msec, p=0.658) were not significantly different between patients on hydroxychloroquine or a combination of hydroxychloroquine and lopinavir-ritonavir. Five (16.7%) patients had QTc of 500msec or more. Four (13.3%) patients required discontinuation of hydroxychloroquine and 3 (10.0%) patients required discontinuation of lopinavirritonavir due to QTc prolongation. However, no torsade de pointes was observed.

    CONCLUSIONS: QTc monitoring using smartphone electrocardiogram was feasible in COVID-19 patients treated with hydroxychloroquine with or without lopinavir-ritonavir. The usage of hydroxychloroquine and lopinavir-ritonavir resulted in QTc prolongation, but no torsade de pointes or arrhythmogenic death was observed.

  4. Chin YH, Yap YL, Chin HH, Lau BK
    Med J Malaysia, 2021 07;76(4):606-609.
    PMID: 34305132
    Madam LPS, a 69 years old lady complained of left eye blurring of vision since January 2017. It was associated with left orbital swelling with chemosis, eye redness, epiphora, several episodes of self-limiting epistaxis and bilateral ophthalmoplegia. Other neurological examinations and cerebellar systems were intact. Magnetic Resonance Imaging (MRI) Brain and Orbit were performed, depicting a sellar mass with suprasellar extension with blood investigations results showed panhypopituitarism. She underwent bilateral orbital decompression. Trans-nasal endoscopic biopsy showed suppurative granulomatous lesion, which cultured Candida Albicans and Candida Galbrata. She was started on antifungal and hormonal replacement therapy for panhypopituitarism. Unfortunately, she did not respond well to treatment as repeated MRI Brain on December 2018 showed increase in size of sellar mass causing obstructive hydrocephalus and increasing size of left orbital lesion. She was counselled for another debulking surgery with a ventriculoperitoneal (VP) shunt. HPE taken were reported as chronic inflammatory process in favour to fungal infection. Pituitary infections may mimic pituitary mass. Some may exhibit symptoms of panhypopituitarism as well. Thus, physical examination, MRI brain imaging as well as HPE of biopsy are important aids to achieve diagnosis. Optimal treatment of fungal pituitary abscess includes transsphenoidal surgery combined with antifungal therapy.
  5. Rasid MF, Ahmad A, Baharuddin KA, Salim AA, Savarirajo JC, Abdullah MS
    Med J Malaysia, 2021 07;76(4):603-605.
    PMID: 34305131
    Acute compartment syndrome (ACS) is a surgical emergency that requires timely recognition and early management for a good outcome. We report a case of a 71- year-old male seen at the Emergency Department of Universiti Sains Malaysia (USM), Malaysia, on anticoagulant therapy for valvular atrial fibrillation, who had sustained a closed fracture of the left distal end radius following a fall. Examination of the left upper limb showed deformity and tenderness over the left wrist, associated with swelling and a tense anterior compartment with blisters formation and rapid expansion of hematoma at the cubital fossa away from the fracture site. Both radial and brachial pulses were absent and confirmed with the absence of a doppler signal over the brachial and radial artery and CT angiography of the left upper limb showed there was a vascular injury of the brachial artery. Fasciotomy of the left upper limb and revascularization of the left brachial artery was done. Intraoperative findings showed a tight anterior compartment with muscle bulging upon compartment release with a complete cut of the left distal brachial artery. The primary end-to-end vascular anastomosis was done and distal circulation was restored. The distal end radius fracture was treated conservatively. The patient underwent split skin grafting of the left forearm after 6 weeks post-injury and went home well. It is critical to recognize a concomitant vascular injury in fracture-related ACS as the clinical feature may overlap. Failure in detection of concomitant vascular injury may lead to emergency fasciotomy without vascular exploration and repair.
  6. Lai WC, Low KY, Thomas M
    Med J Malaysia, 2021 07;76(4):594-596.
    PMID: 34305128
    Post Endoscopic Retrograde Cholangiopancreatography (ERCP) pneumoperitoneum is commonly associated with perforated viscus but is rarely associated with benign causes. We present a case of 29 years old lady who underwent ERCP, who was found to have benign pneumoperitoneum subsequently. She was treated conservatively and recovered without complication. Although rare, post ERCP pneumoperitoneum of benign causes should be investigated as the course of treatment and outcome differ largely.
  7. Tan YH, Ong JYK, Devendra K
    Med J Malaysia, 2021 07;76(4):591-593.
    PMID: 34305127
    Acute pancreatitis (AP) is a serious condition that can occur suddenly in pregnancy. We present a case of sudden onset of epigastric pain with severely deranged serum triglyceride levels in a 32-year-old Vietnamese primigravida with no significant past medical history in the Singapore General Hospital. The patient was managed in the intensive care unit, with plasmapheres and intravenous insulin and was eventually a healthy term foetus was delievered via ceasarian section. This case showcased multidisciplinary co operation between the obstetrics, anaesthetic, endocrinology and intensive care team and serves as a reminder to consider this rare condition for future similar presentations.
  8. Chin YH, Yap YL, Chin HH, Sarina S
    Med J Malaysia, 2021 07;76(4):600-602.
    PMID: 34305130
    The thyroid gland and its hormones play important roles in organ development and in the homeostatic control of physiological mechanisms in human beings. As a result of embryogenic descent of thyroid gland, it commonly resides along the midline - from tongue to mediastinum (90%). Ectopic thyroid gland is a rare occurrence, with extra-lingual ectopic thyroid gland being even rarer. Thus, there is a concern for malignant metastasis. Madam H, a 56-year-old healthy woman presented to the Hospital Sultanah Nora Ismail, Johor, Malaysia in April 2020 with an increasing size of right axilla mass and history of weight loss. She was having right axilla mass for the previous 7 years but only noticed the increase in size about 1 year ago. She has no other constitutional symptoms. A tru-cut biopsy performed demonstrated a benign ectopic thyroid tissue. Thyroid function test showed primary hypothyroidism. Serum Chromogranin A and other thyroid antibodies were within the normal value. Further radiological imaging showed the normal thyroid gland at neck, with no signs of distant malignancy. There was no other axillary, mediastinal or hilar lymph node enlargement. She was started on regular T. L Thyroxine 100mcg daily and given regular follow-up in endocrine clinic. Benign ectopic thyroid gland is an unusual finding. As such, follow up is needed with possibility of carcinomatous transformation such as papillary carcinoma should be considered.
  9. Soo WT, Lau KS, Yong SG, Soon KC
    Med J Malaysia, 2021 07;76(4):597-599.
    PMID: 34305129
    Giant splenic cyst is rare disorder affecting the spleen. As the occurrence is so in-frequent that the diagnosis preoperatively remains a challenge. We report a 12-year-old boy who presented to Sarawak General Hospital, Malaysia with left upper abdominal pain initially mistaken as a complex left liver cyst. He underwent surgery which turned out to be a giant splenic cyst and underwent laparotomy and total splenectomy. He was discharged well and remains asymptomatic after 6 months postoperative follow up.
  10. Hanafi MH, Mohd Noor N, Ahmad Saad FF, Ramli SH, Mohamed F, Musarudin M
    Med J Malaysia, 2021 07;76(4):551-561.
    PMID: 34305117
    INTRODUCTION: There has already been a rising demand in utilising phantom for hybrid Positron Emission Tomography/ Computed Tomography (PET/CT) scanner of nuclear imaging. This review further clarifies this topic and investigates how the previous research phantoms operated with the need for quantitative hybrid nuclear imaging of PET/CT while providing a relatively high image quality when it was performed. In this article, the necessity of previous and current phantom studies in hybrid nuclear imaging of PET/CT scanners is reviewed.

    METHODS: PubMed and Google Scholar were systematically searched for the relevant studies by following the PRISMA 2009 checklist. A past decade literature search was conducted from 2010 until November 2020 to secure the relevance of the phantom study. Databases were recruited using keywords such as phantom, quantification, standardisation, harmonisation, image quality, standardised uptake value and multicentre study. However, all keywords were related to PET/CT. All abstracts and eligible full-text articles were screened independently, and finally, the quality assessments of this review were performed.

    RESULTS: From the 200 retrieved articles, 80 were rejected after the screening of the abstracts and 35 after reading the full-text. The 20 accepted articles addressed the distribution of phantom types used in selected articles studies which were NEMA (67%), ACR (8%) and others (25%). The articles showed the various experimental studies, either phantom studies (35%) or phantom plus clinical studies (65%). For clinical studies (n = 829), the distribution of prospective studies was (n = 674) and retrospective studies was (n =155). The distribution of phantom pathway application showed the studies focused on 40% of reconstruction protocol studies, 30% of the multicentre and standardisation of accreditation program studies, and 30% of the quantification of uptake values studies.

    CONCLUSIONS: According to this review, the phantom study have a pivotal role in hybrid nuclear imaging of PET/CT either in technical aspects of the scanners (such as data acquisition and reconstruction protocol) or clinical characteristics of patients. In addition to this, the necessity to identify the suitable system phantoms to use within PET/CT scans by considering the continuous development of new phantom studies are needed. Researchers are encouraged to adopt efforts on phantom quantitative validation, including verification with clinical data of patients.

  11. Abd Talib AKA, Tan SC, Jamal R, Azizan EA, Shaharir SS, Abdul Murad NA
    Med J Malaysia, 2021 07;76(4):541-550.
    PMID: 34305116
    INTRODUCTION: Systemic lupus erythematosus (SLE) is a chronic and life-threatening autoimmune disease. Its prevalence and clinical manifestations are known to be particularly severe in the Asian populations. Although genetics is known to play an important role in SLE susceptibility and clinical manifestations, the specific polymorphisms associated with these phenotypes in Asia are unclear. Therefore, we aim to review the association of SLE genetic polymorphisms with lupus manifestations across Asian populations and their role in the pathogenesis of SLE.

    METHODS: A systematic search was conducted on PubMed, EBSCOHost, and Web of Science. We identified 22 casecontrol studies that matched our inclusion and exclusion criteria. Information such as study characteristics, genetic polymorphisms associated with SLE, and organ manifestations was extracted and reported in this review.

    RESULTS: In total, 30 polymorphisms in 16 genes were found to be associated with SLE among Asians. All included polymorphisms also reported associations with various SLE clinical features. The association of rs1234315 in TNFSF4 linking to SLE susceptibility (P=4.17x10-17 OR=1.45 95% CI=1.34-1.59) and musculoskeletal manifestation (P=3.35x10-9, OR=1.37, 95%CI= 1.23-1.51) might be the most potential biomarkers to differentiate SLE between Asian and other populations. In fact, these associated genetic variants were found in loci that were implicated in immune systems, signal transduction, gene expression that play important roles in SLE pathogenesis.

    DISCUSSIONS AND CONCLUSIONS: This review summarized the potential correlation between 30 genetic polymorphisms associated with SLE and its clinical manifestations among Asians. More efforts in dissecting the functional implications and linkage disequilibrium of associated variants may be required to validate these findings.

  12. Ng HR, Cheong MY, Mustapha M
    Med J Malaysia, 2021 07;76(4):569-572.
    PMID: 34305121
    Leptospirosis is a zoonotic disease that is caused by the pathogenic spirochetes of the genus Leptospira. The infection occurs worldwide and is particularly more common in the tropics. However, it is becoming a neglected reemerging global health disease due to rapid urbanisation. This disease has a wide range of clinical manifestations from flu-like illness to pneumonia, acute kidney injury, etc. But many uncommon clinical findings are being reported as well. In this paper, we report four patients who presented initially with uveitic features who turned out serologically positive for Leptospira after extensive investigations.
  13. Khoo WV, Choo YM, Zahari N, Kamar AA
    Med J Malaysia, 2021 07;76(4):566-568.
    PMID: 34305120
    Pericardial effusion (PCE) and cardiac tamponade (CT) are rare but life-threatening complications of percutaneouslyinserted central catheter (PICC) use in neonates. There is often a lack in index of suspicion in a neonate with sudden deterioration, resulting in high mortality. We describe a series of three cases of PICC-related PCE/CT in low birth weight infants whose timely diagnosis with echocardiography and pericardiocentesis led to successful resuscitation and survival. We suggest that echocardiographic skills to determine tip position and pericardiocentesis be taught in neonatal resuscitation programs to ensure good outcomes of this otherwise fatal complication.
  14. Mohd Zahid AZ, Abdul Rahman N, Ahmad ZA
    Med J Malaysia, 2021 07;76(4):585-587.
    PMID: 34305125
    Adenomyosis is a common gynaecological condition encountered in clinical practice. Treatment of adenomyosis can present a great challenge to gynaecologists as women often become resistant to hormonal treatment eventually needing surgical intervention. Hysterectomy has long been the definitive treatment for adenomyosis. However, with women currently being diagnosed at an earlier age and still have not completed their family, there is an increasing demand for effective intervention with uterine conservation. We report here two cases of patients who had undergone a combination of hysteroscopic resection of the endomyometrium combined with Mirena insertion with successful outcome.
  15. Arumugam M, Leelavathi M, Harun NL, Jamil A
    Med J Malaysia, 2021 07;76(4):583-584.
    PMID: 34305124
    Cutaneous sporotrichosis (CS) presents as asymptomatic lesions of varied morphology. The most common variant is the lymphocutaneous type which typically progresses from a papule to an ulcer and then forms nodules along the superficial lymphatic channels. Diagnosis CS may be challenging when the lesion presents at an uncommon site where the superficial lymphatic drainage is unfamiliar. We present here a case of sporotrichosis of the abdominal wall which was initially misdiagnosed as an abscess but later confirmed by culture and managed successfully.
  16. John Lim BB, Yong CM
    Med J Malaysia, 2021 07;76(4):534-540.
    PMID: 34305115
    BACKGROUND: The significance of pelvic and para-aortic lymph nodes (retroperitoneal lymph nodes) metastasis in the five-year survival of early stage cervical cancer (CC) patients is well established. The previous International Federation of Gynaecology and Obstetrics (FIGO) 2009 staging of CC was clinical and excluded advanced radiological assessment in assigning a stage. However, with the current FIGO 2018 staging, advanced radiological assessment and pathological findings were allowed to assign a stage which would alter the subsequent management. This pilot study aims to obtain local data on the correlation between radiological retroperitoneal lymph node positivity and histological lymph node positivity in early stage CC (stage 1A2 to 2A1) and seeks to correlate independent prognostic factors for recurrence to histological lymph node positivity.

    MATERIALS AND METHODS: In this retrospective cross-sectional analysis, clinical data, including clinical staging, Computed Tomography (CT) scan findings and histopathological results were collected and analysed in the Department of Obstetrics and Gynaecology, Hospital Ampang, Ministry of Health Malaysia.

    RESULTS: A total of 31 patients had surgery for CC from 1st August 2018 till 31st August 2020. Radical hysterectomy was done on 23 of them as primary treatment for early stage cervical cancer. Both pelvic and para-aortic lymph node dissection was done in 6 patients while 17 patients had only pelvic lymph node dissection. All patients had thoracoabdomino- pelvic CT scans done preoperatively. Among the 82.6% patients with no enlarged pelvic lymph nodes on CT scan, all were confirmed by histology to be negative of malignancy. In the remainder 17.4% of patients with enlarged pelvic nodes on CT scan, three quarters had histology positive pelvic nodes for malignancy (p=0.002). Among patients with no enlarged para-aortic lymph nodes on CT scan, 83.3% had histologically negative para-aortic nodes. Among patients with clinical tumour diameter 2- 3.9 cm, 14.3% had positive pelvic nodes while a quarter of patients with clinical tumour diameter ≥ 4cm had histological positive pelvic nodes. None of the patients with tumour diameter < 2cm had positive pelvic nodes (p=0.993). Positive pelvic lymph nodes involvement was present in 37.5% of those with positive lymphovascular space invasion (LVSI). All patients with negative LVSI had no histological positive pelvic nodes (p=0.103). Among patients with tumour invasion involving the inner third of the stroma, 16.7% had histological positive pelvic nodes while 18.2% with outer third stromal invasion had positive nodes (p=0.977). None of the patients had histologically positive para-aortic lymph nodes with negative pelvic lymph nodes. Among patients with clinical stage 1B2, 20% would have been upstaged to stage 3C based on radiological imaging and final histology confirmation.

    CONCLUSION: This study shows that in early stage CC, there is a statistically significant correlation between CT scan findings of enlarged pelvic lymph nodes and histological positive pelvic lymph nodes.

  17. Koo SX, Tong AK, Soh SY, Farid M, Loh A, Loke KS
    Med J Malaysia, 2021 07;76(4):573-577.
    PMID: 34305122
    Adult neuroblastoma (AN) is rare with an extremely poor prognosis. No standard therapy exists for this entity and treatment options are limited in recurrent or refractory disease. 131I-MIBG has been used in combination with myeloablative therapy before autologous bone marrow transplantation or in a salvage therapy setting. However, myelotoxicity is a dose-limiting factor in heavily pre-treated patients and response is not always sustained. Somatostatin receptor scintigraphy and theranostics with radiolabelled somatostatin receptor analogues are becoming more commonplace with the recognition of these receptors in over 90% of neuroblastoma cells. We describe three AN patients assessed for somatostatin receptor status and the novel use of 177Lu-based peptide recep-tor radionuclide therapy (PRRT) in two of them and a literature review.
  18. Imataka G, Otsubo Y, Fujita Y, Yoshihara S
    Med J Malaysia, 2021 07;76(4):588-590.
    PMID: 34305126
    Globally, vaccination has reduced the prevalence of meningitis caused by Streptococcus pneumoniae Neisseria meningitidis, and Haemophilus influenzae. However, neonatal Group B Streptococcus (GBS) meningitis continues to remain a problematic infection of the central nervous system. Here, we report a case of bacterial meningitis in a 34-day old male baby who presented with fever. A cerebrospinal fluid (CSF) test on the day of admission showed an increase in cell count with decreased glucose level. A rapid latex test of the CSF using a commercial kit diagnosed the causative pathogen as GBS. We administered the antibiotics ampicillin, cefotaxime, gentamicin and panipenem/betamipron to the patient for over 14 days. Partial seizures were frequently observed during the course and were well-controlled with midazolam and phenobarbital. Brain magnetic resonance imaging on day 17 showed subdural hygroma in the frontal region, and 99mTc ethyl-cysteinate dimer-single photon emission computed tomography confirmed a decreased cerebral blood flow predominantly in the left frontal region. After three years of follow-up, the condition of the patient improved without any neurological sequelae. Our report highlights that rapid identification of the causative organism is essential in infantile late-onset meningitis. In addition, we consider that the latex kit-based rapid testing of CSF is beneficial for identifying the causative agent of bacterial meningitis.
  19. Nur Rafidah M, Mohd Wafi M, Sazlina K, Omar R
    Med J Malaysia, 2021 07;76(4):578-582.
    PMID: 34305123
    The ability to detect and recognise visual deficits among visually impaired patients can improve the management of daily living skills and activities of these patients. In this report, the importance of using objective and subjective visual performance measures by occupational therapists in managing visually impaired patients is discussed. We describe a case of a 17-year-old Malay female who had vision impairment due to a cataract, a secondary complication from diabetes mellitus (DM). The Brain Injury Visual Assessment Battery for Adult (biVABA) can provide occupational therapists with additional visual performance information and a better understanding of managing visually impaired patients. The biVABA was used in conjunction with other activities of daily living skills tools such as Modified Barthel Index (MBI), Lawton Instrumental Activities of Daily Living Scale (IADL) and EVS Orientation and Mobility Screening (EVS-O&M) for a more holistic assessment. This approach provides more relevant and essential information in managing visually impaired patient rehabilitation from the occupational therapy perspective.
  20. Wong KC
    Med J Malaysia, 2021 07;76(4):565.
    PMID: 34305119
    No abstract provided.
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