MyMedR

Rare middle ear anomaly in a patient with Turner's syndrome

Hamzah AR, Jalaluddin MA, Raman R

Ann Otol Rhinol Laryngol, 1999 Mar;108(3):253-4.

A patient with Turner's syndrome presented with a rare anomaly of absent oval window, inferiorly placed facial nerve, and abnormal stapes. To our knowledge, this is the first report of this combination of malformations.

Matched MeSH terms: Female

Fulltext Non-sporulating Chrysosporium: an opportunistic fungal infection in a neutropenic patient

Gan GG, Kamarulzaman A, Goh KY, Ng KP, Na SL, Soo-Hoo TS

Med J Malaysia, 2002 Mar;57(1):118-22.

PMID: 14569730

We report a case of an invasive infection with non-sporulating Chrysosporium species in a patient who was treated with chemotherapy for relapsed acute lymphoblastic leukemia. This patient presented with a persistent lobar pneumonia, skin lesions, and possible involvement of the central nervous system. The patient responded to treatment with amphotericin B and oral itraconazole.

Matched MeSH terms: Female

Fulltext Clinical profile of acute flaccid paralysis

Rasul CH, Das PL, Alam S, Ahmed S, Ahmed M

Med J Malaysia, 2002 Mar;57(1):61-5.

PMID: 14569719

This study was done to determine the clinical course, cause and outcome of Acute Flaccid Paralysis (AFP) in children. All AFP cases (< 15 years) in the children's ward of Khulna Medical College Hospital (Bangladesh) were recorded, investigated and followed up to sixty days as a part of passive surveillance. Main outcome variables were vulnerable age group, vaccine status, predominant limb involvement, clinical variants, virus isolation and residual paralysis. Thirty-four children with AFP were admitted in hospital in the last three years with the highest number (14) in 1998. The majority of children belonged to the age group 5-9 years with a male female ratio of 1.3:1. Nearly one third of the cases were either partially vaccinated or not vaccinated at all. The lower limbs bore the brunt of paralysis excepting a few (14.7%). Clinically, Guillain Barre Syndrome was the commonest (47.1%) followed by encephalomyelitis. No poliovirus was isolated from these cases. Residual paralysis was observed in four out of ten cases who returned for follow up. AFP will continue to occur even after eradication of poliomyelitis and Guillain Barre Syndrome is the most important clinical entity for this.

Matched MeSH terms: Female

Medical care for people under detention

Ritom MH

Med J Malaysia, 2003 Mar;58 Suppl A:72-7.

PMID: 14556353

Human Rights traditionally refer to rights and freedom that are inherent to every human being. They are based on Human Rights Law and concern the respect for dignity and worth of a person. These rights are universal, inalienable, indivisible, inter-related and interdependent. Members of Societies are detained for varied reasons and are made up of different age groups and gender. The United Nations through its numerous agencies, associated Conventions, Treaties and Resolutions have laid down guidelines that govern the rights of those under detention. Article 5 of General Assembly Resolution 45/111 clearly stipulates that except for those limitations that are demonstrably necessitated by the fact of incarceration, all prisoners shall retain the human rights and fundamental freedom set out in the Universal Declaration of Human Rights. As such, the Medical and Health Care of People under Detention should not be any different from the other members of societies. The Right to Health and Medical Care is stipulated under various Articles contained in the UN Bill of Human Rights (UDHR, ICCPCR and ICESCR) as well as other Conventions, e.g. Convention against Torture (CAT), Convention on Rights of the Child (CRC) and Convention for the Extinction of all Forms of Discrimination against Women (CEDAW). The United Nations have also developed specific guidelines and instruments for Treatment of People under Detention. These include the General Assembly Resolution 45/111 December 1990 elucidating the Basic Principles for Treatment of Prisoners, ECOSOG resolution 663C and 2076 regarding the Standard Minimum Rules for the Treatment of Prisoners which covers rules pertaining to accommodation and Medical Services, General Assembly Resolution 37/194 on Principles of Medical Ethics relevant to the role of health personnel, particularly Physicians, in the Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment.

Matched MeSH terms: Female

Medical misadventures

Lewis K

Med J Malaysia, 2003 Mar;58 Suppl A:68-71.

PMID: 14556352

Historical perspective of terminations of unwanted pregnancies in the UK. Moral and ethical considerations imposed by established church's teachings becoming increasingly in conflict with the wishes and expectations of a more secular society. Recognition that illegal abortion was, as a matter of fact available, at great risk to vulnerable girls and women. Eventually public demand and a radical and reforming government led to the current Statutory Framework. Statutory provisions: Offences against the Person Act 1861, Sections 58 and 59; Infant Life Preservation Act 1929 Section 1. Recognition of the limited flexibility allowed by the law in the original restrictive statutory framework. The direction to the jury in July 1938 by Macnaghten J in the case of R. v. Bourne [1939] 1 KB 687, where an eminent obstetrician was acquitted after carrying out an abortion on a young rape victim. Then the modern statutory provisions: Abortion Act 1967, amended by the Human Fertilisation and Embryology Act 1990. The statutory framework provides for healthcare professionals not to have to take part in terminations if they have a conscientious objection to doing so. While there are still fierce challenges from moral pressure groups when any changes in the detail of the law are proposed--such as reducing the maximum gestation period for a lawful termination--as a whole society seems to have accepted the current law. Issues affecting doctors who consider and provide terminations; current medico-legal problems relating to wanted pregnancies that have been lost by reason of clinical negligence, and unwanted children that have been born by reason of clinical negligence.

Matched MeSH terms: Female

Hyalinizing clear cell carcinoma of minor salivary gland: case report

Manoharan M, Othman NH, Samsudin AR

Braz Dent J, 2002;13(1):66-9.

PMID: 11870967

Hyalinizing clear cell carcinoma is a low-grade neoplasm of the minor salivary gland composed exclusively of epithelial cells and not myoepithelial cells. It predominantly affects the oral cavity of adult females. It is microscopically characterized by hyalinizing stroma and clear cells, which are typically positive for cytokeratin markers and negative for S 100 and smooth muscle actin (SMA). Cystic degeneration can also be present. Pathologists should be aware of this new entity so as not to misdiagnose otherwise. To our knowledge, this is the first case report of its kind from Malaysia.

Matched MeSH terms: Female

Total thyroidectomy: the procedure of choice for multinodular goitre

Hisham AN, Azlina AF, Aina EN, Sarojah A

Eur J Surg, 2001 Jun;167(6):403-5.

PMID: 11471662 DOI: 10.1080/110241501750243725

OBJECTIVE: To review our experience of total thyroidectomy for bilateral multinodular goitre.
DESIGN: Prospective open study.
SETTING: Teaching hospital, Malaysia.
SUBJECTS: 98 consecutive patients whose bilateral multinodular goitres were treated by total thyroidectomy, January 1998-November 1999.
INTERVENTION: A revised technique of total thyroidectomy in which more attention than is customary was paid to the exposure and safety of the laryngeal nerves and the parathyroid glands. All patients had at least 1 parathyroid gland autotransplanted.
MAIN OUTCOME MEASURES: Morbidity and mortality
RESULTS: There were no injuries to the recurrent laryngeal nerves and no patient developed persistent hypocalcaemia; 27/98 developed transient hypocalcaemia, but this had settled by 6 months postoperatively. 59 patients had persistent symptoms of pressure preoperatively, and these all resolved by 3 months postoperatively. 6 patients had occult malignant disease discovered on histological examination, and 3 developed minor wound infections.
CONCLUSIONS: Total thyroidectomy is the procedure of choice for bilateral multinodular goitres, provided that sufficient attention is paid to the preservation of the laryngeal nerves and the parathyroid glands.

Matched MeSH terms: Female

Fulltext Interstitial lung disease in children--a report of four cases

Norzila MZ, Azizi BH, Deng CT, Zulfiqar A

Med J Malaysia, 1997 Dec;52(4):429-32.

PMID: 10968122

Interstitial lung disease (ILD) is very rare in children. In the majority of cases the aetiology is unknown. Very little is known about the clinical course of this condition in children. Prognosis may be influenced by sex, age of onset of symptoms, radiographic features, presence of right ventricular hypertrophy and histopathology. We report our experience in managing four children with interstitial lung disease. All these children presented in early infancy with cough, respiratory distress, cyanosis and failure to thrive. Three of these children had finger clubbing and right ventricular hypertrophy. All patients received oral steroids. Chloroquine was added in two patients who showed no response. A trial of oral cyclophosphamide was started in one patient who failed with both drugs. One child is oxygen independent while another is on home oxygen therapy. The other two patients eventually died.

Matched MeSH terms: Female

Fulltext Rabies raises its ugly head once more

Lim KG

Med J Malaysia, 1998 Mar;53(1):4-5.

PMID: 10968129

Matched MeSH terms: Female

Fulltext Nifedipine-induced hypotensive shock

Ramanathan M, Ahmad F

Med J Malaysia, 1997 Dec;52(4):444.

PMID: 10968126

Matched MeSH terms: Female

Fulltext Revisiting the obstetric flying squad

Ravindran J, Parampalam SD

Med J Malaysia, 2000 Jun;55(2):280-2.

PMID: 19839163

The obstetric flying squad has been used in obstetric practice since 1933 to manage obstetric emergencies occurring in domicilliary practice. It has often been criticised in such situations as only delaying effective treatment to the patient. We have introduced the obstetric flying squad in an urban setting to cater for obstetric emergencies occurring in private practice. This service has been used on ten occasions since its inception without any maternal deaths being recorded or any delay in the provision of emergency care. The flying squad has led to closer cooperation between the government and private sectors in providing obstetric care.

Matched MeSH terms: Female

Tuberculous pleurisy as a manifestation of primary and reactivation disease in a region with a high prevalence of tuberculosis

Liam CK, Lim KH, Wong CM

Int J Tuberc Lung Dis, 1999 Sep;3(9):816-22.

PMID: 10488891

A teaching hospital in Malaysia.

Matched MeSH terms: Female

Fulltext Pregnancy in patients with renal transplants in Malaysia

Hooi LS, Rozina G, Wan Shaariah MY, Teo SM, Tan CHH, Bavanandan S, et al.

Med J Malaysia, 2003 Mar;58(1):27-36.

PMID: 14556324

There were 72 pregnancies in 46 renal transplants (RTs) between 1984 and 2001, 89% from living donors, 11% cadaveric. Mean age at RT was 26.9 +/- 4.3 years and at pregnancy 30.7 +/- 4.7 years. Mean time to pregnancy after RT was 4.5 +/- 3.1 years. 54% were unplanned. 45 (63%) resulted in surviving infants, 37% delivered by Caesarean section. 35% were premature. Mean birth weight was 2.38 +/- 0.57 kg. 64% were on cyclosporine. No patient had an acute rejection during pregnancy; 38% had pre-existing hypertension. Complications include urinary infection (13%), proteinuria (15%) and preeclampsia (15%). Mean serum creatinine before pregnancy was 112.7 +/- 32.6 umol/l, 1 year post-pregnancy it was 119.4 +/- 38.7. The mean time of follow up of mothers is 4.9 +/- 3.5 years. 10 year graft survival was 83% and patient survival 94%.

Matched MeSH terms: Female

Fulltext Quality of life--how do Malaysian asthmatics fare?

Sararaks S, Rugayah B, Azman AB, Karuthan C, Low LL

Med J Malaysia, 2001 Sep;56(3):350-8.

PMID: 11732082

Asthma can place considerable restrictions on the physical, emotional and social aspects of the lives of patients. The assessment of quality of life aims to provide a means of measuring the impact of this disease on patients' lives, from the patients' perspective. A cross sectional multi-centre study was conducted in six government hospitals throughout the country. Self-administered SF-36 was used, and clinical information obtained through interviews and examination. 1612 asthmatics responded. Females constituted 63% of the respondents; mean age was 40.9 years; Malays were the majority ethnic group, while 70.8% had secondary level education and 53.7% were employed. Half had suffered from asthma for at least 13 years, while 46.8% and 23.6% have moderate and severe disease respectively. Quality of life was affected by severity of disease. Asthmatics, had a significantly poorer quality of life than the general US population. Severe asthma disease was associated with a compromised quality of life, similar to that of COPD.

Matched MeSH terms: Female

Fulltext Gender differences in the clinical and serological features of systemic lupus erythematosus in Malaysian patients

Azizah MR, Ainol SS, Kong NCT, Normaznah Y, Rahim MN

Med J Malaysia, 2001 Sep;56(3):302-7.

PMID: 11732074

An analysis of the clinical and serological features of 12 male and 122 female patients with SLE was done to determine whether sex related differences exist. We found a lower incidence of mucocutaneous symptoms and arthritis but an increased incidence of discoid lesions, pleuritis and pericarditis in males at disease onset. During the disease course, there was a lower incidence of arthritis, a similar prevalence of mucocutaneous symptoms but an increased incidence of pleuritis in males with a trend towards renal involvement. These findings were however not statistically significant except for the higher incidence of thrombosis among males. Serologically, both groups showed similar frequencies of autoantibodies and hypocomplementaemia. Although the study was small, it was shown that several sex-related differences in the clinical and serological features exist in Malaysian SLE patients.
Study site: SLE Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia

Matched MeSH terms: Female

Fulltext Balloon endometrial thermoablation--an alternative management of adenomyosis with menorrhagia and dysmenorrhoea

Chan CLK, Annapoorna V, Roy AC, Ng SC

Med J Malaysia, 2001 Sep;56(3):370-3.

PMID: 11732085

A 45 years old Chinese housewife presented with menorrhagia and dysmenorrhoea due to adenomyosis failed to respond to various medical treatments. She was treated with balloon thermoablation. The total menstrual blood loss (MBL) decreased from 96.94 ml before to 37.57 ml, six months after thermoablation. The pictorial blood loss chart (PBLC) showed similar decrease in blood loss. Dysmenorrhoea was also cured. At three year follow up, there was no recurrence. This is the first report which shows thermoablation decreases MBL objectively and can be tried to treat adenomyosis.

Matched MeSH terms: Female

Fulltext The timing and stability of choice of medical specialty among Malaysian doctors

Rogayah J, Zulkifli A

Med J Malaysia, 2001 Sep;56(3):324-30.

PMID: 11732078

A total of 356 doctors responded to a survey on the timing and stability of choice of medical specialty. The majority of doctors made their final decision while working as a medical officer. One hundred (48.5%) of the doctors had made an earlier choice as medical students, 63 (30.6%) during their internship and 43 (20.9%) made their final choice while they were medical officers. Working experience in the specialty was the most important factor in determining final choice of specialty. Advice from consultants/seniors, better financial prospects and parental influence were more important for the male doctors while marriage and family considerations were more important for the female doctors in making their final choice.

Matched MeSH terms: Female

Severe upper airway obstruction in the tropics requiring intensive care

Chan PW, Goh A, Lum L

Pediatr Int, 2001 Feb;43(1):53-7.

PMID: 11208000

BACKGROUND: The clinical profile of severe upper airway obstruction, a challenging acute pediatric emergency, has not been extensively documented in the developing nations of the tropics.

METHODS: The diagnostic categories, severity of illness and outcome from 63 episodes of severe upper airway obstruction in 56 children admitted to the Pediatric Intensive Care Unit between January 1994 and December 1999 were reviewed. Outcome variables studied included requirement for ventilation, mortality and complications. Severity of illness was determined with the Pediatric Risk of Mortality (PRISM) II score.

RESULTS: Viral croup (29%) was the most common diagnosis, followed by mediastinal malignancy (13%), bacterial tracheitis (11%) and Pierre Robin syndrome (11%). There were no admissions for acute epiglottitis. Thirty episodes (48%) required ventilation for a median duration of 4.0 days. Bacterial tracheitis (100%) and subglottic stenosis (100%) were the most likely diagnoses requiring ventilation. Difficulty in intubation was encountered in 13 episodes (43%) involving, in particular, patients with bacterial tracheitis (83%; P = 0.006). Only two patients required a tracheostomy. The overall mortality was 11%. The PRISM score for all categories was generally low (mean 10.3 +/- 1.0; median 9.0). Non-survivors had a significantly higher PRISM II score than survivors (27.4 +/- 9.7 vs 8.1 +/- 4.9, respectively; P = 0.002) and were more likely to include children with bacterial tracheitis and mediastinal malignancy.

CONCLUSIONS: There is marked heterogeneity in the causes of upper airway obstruction in the tropics with viral croup remaining the most common. A significant proportion required ventilation, but outcome is generally favorable, except in those with bacterial tracheitis and mediastinal malignancy.

Matched MeSH terms: Female

Fulltext Deaths following acute diarrhoeal diseases among hospitalised infants in Kuala Lumpur

Lee WS, Ooi TL

Med J Malaysia, 1999 Sep;54(3):303-9.

PMID: 11045055

The risk factors and modes of death following acute diarrhoeal illness in children admitted to University Hospital, Kuala Lumpur between 1982 and 1997 were studied retrospectively. Among 4,689 cases of acute gastroenteritis admitted, ten deaths were noted. The case mortality rate was 2.1/1000 admissions. All deaths were infants below one year, with eight females and two males. Acute renal failure and acute pulmonary oedema were common preceding events. Female sex, infants less than twelve months, the presence of hyper or hyponatraemia and moderate to severe dehydration on admission were risk factors for deaths.

Matched MeSH terms: Female

Fulltext Scoliosis in a patient with lipodystrophy--treatment difficulties and literature review

Lim HH, Chong CS

Med J Malaysia, 1999 Sep;54(3):368-70.

PMID: 11045066

A 12 year-old Chinese schoolgirl presented with left-sided scoliosis at the age of 9 years. She has a rare defect in lipid metabolism, which is not known to be associated with spinal deformity. Her scoliotic curve deteriorated despite bracing. We report a rare occurrence of scoliosis in patient with lipodystrophy and the difficulty of using instrumented fusion in treating this condition.

Matched MeSH terms: Female

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