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  1. Teoh KH, Balraj S, Navarasi SR
    Med J Malaysia, 2017 02;72(1):68-70.
    PMID: 28255147 MyJurnal
    Intrapancreatic accessory spleen (IPAS) is a benign anomaly of splenic embryology and a rare cause of pancreatic pseudotumour. Here, we report a case of a 70-year-old Malay lady whose IPAS was discovered incidentally during her surveillance computed tomography for her underlying left lower lung fibrosis. Radiologically, the lesion mimicked a neuroendocrine pancreatic tumour and was only diagnosed pathologically as IPAS after surgery. In conclusion, recognising IPAS as a differential for enhancing pancreatic mass allows us to exhaust all non-invasive diagnostic means to diagnose this benign lesion. It will allow the patient to avoid unnecessary surgery and its accompanying complications.
  2. Huei TJ, Lip HT, Rahman MS, Sarojah A
    Med J Malaysia, 2017 02;72(1):65-67.
    PMID: 28255146 MyJurnal
    The literature on adrenal gland tumour in HIV-infected patients is scarce. We report a 46-year-old Malay man with HIV and Hepatitis C infection presenting with a large nonfunctioning adrenal tumour. Computed tomography showed a large right adrenal tumour with heterogeneous enhancement and central necrosis. A high index of suspicion of a malignant tumour or pheochromocytoma led us to surgical removal of the adrenal gland. In this case report, we highlight important features to look for during pre-op evaluation of a large adrenal mass. Appropriate action should be taken when there is a suspicion of a pheochromocytoma or malignancy.
  3. Krishnamoorthy A, Hadi FA, Naidu A, Sathar J
    Med J Malaysia, 2017 02;72(1):53-54.
    PMID: 28255141
    Anaemia is a common condition in Malaysia, and is mostly due to iron deficiency. In many cases, allogeneic blood transfusion (ABT) is administered unnecessarily to treat anaemia. Patient blood management (PBM) is a concept whereby a patient becomes his or her "own blood bank", instead of receiving ABT. The concept encompasses three pillars namely optimising erythropoiesis, minimising blood loss and harnessing human physiological reserve. We present a safe and fruitful outcome of managing severe anaemia without utilising any ABT, made possible with the PBM approach including administration of intravenous iron.
  4. Peter CA, Anand Swaroop U, Wong BS
    Med J Malaysia, 2017 02;72(1):58-59.
    PMID: 28255143
    Intra-cardiac extension of hepatocellular carcinoma (HCC) is an uncommon but serious condition related to poor prognosis. We report a 57-year-old male diagnosed with HCC with intra-cardiac extension into the right atrium at presentation. There were no symptoms related to cardiac involvement and intra-cardiac extension was incidentally noted on radiological imaging. He was offered palliative treatment and succumbed to his disease within 50 days of first diagnosis.
  5. Lim CH, Benjamin NH, Kan FK
    Med J Malaysia, 2017 02;72(1):55-57.
    PMID: 28255142 MyJurnal
    Upper gastrointestinal haemorrhage (UGIH) in severe dengue represents a clinical dilemma in term of management. The recommended treatment in dengue with UGIH involves blood product transfusion support and proton pump inhibitor (PPI) infusion. Despite being the mainstay of treatment in non-dengue UGIH, the role of endoscopic haemostatic intervention in severe dengue remains controversial. In the present report, we present a case of severe dengue complicated with upper gastrointestinal haemorrhage successfully underwent early therapeutic endoscopic intervention in a district hospital.
  6. Jasmine YS, Lee SL, Kan FK
    Med J Malaysia, 2017 02;72(1):62-64.
    PMID: 28255145
    Haemophagocytic lymphohistiocytosis (HLH) is a potentially fatal disorder resulting from uncontrolled hyperinflammatory response. There had been increase in cases of one of the secondary form of HLH, i.e., infectionassociated haemophagocytic syndrome (IAHS) in severe dengue in recent years. However, the condition remains under diagnosed due to lack of awareness compounded by the lack of validated diagnostic criteria. Severe hepatitis with prolonged cytopenias, severe hyperferritinemia, hypofibrinogenemia and persistent fever were evident in all four cases reported. All the subjects survived with supportive care and adjuvant steroid therapy. Prospective controlled studies are needed to develop diagnostic criteria and management protocol for IAHS in severe dengue.
  7. Nazli Z, Abdul Fattah AW
    Med J Malaysia, 2017 02;72(1):60-61.
    PMID: 28255144 MyJurnal
    Osteoma is the most common benign tumour of the nose and paranasal sinuses. However, involvement of the sphenoid sinus by osteoma is rare. Most of the time, patients with paranasal sinus osteoma are asymptomatic. However, symptoms may present, depending on the location and extension of the tumour. We report a case of a patient with sphenoethmoidal osteoma found incidentally on imaging, with evidence of impingement onto the optic nerve at the optic canal. However, the patient was asymptomatic. He was surgically treated using the endoscopic transnasal approach.
  8. Michael A, Yahya ZO, Mdrazali I, Hanif H
    Med J Malaysia, 2017 02;72(1):75-76.
    PMID: 28255150 MyJurnal
    Penetrating chest wounds is less common but more deadly then blunt trauma. Majority of penetrating chest trauma can be managed conservatively with observation and simple thoracotomy. This case report highlights a bizarre occupational hazard causing a penetrating chest injury and the option of non-invasive management with the aid of computed tomography with 3D reconstruction.
  9. Chuah KH, Ng CW, Zabri K, Wong CL
    Med J Malaysia, 2017 02;72(1):73-74.
    PMID: 28255149 MyJurnal
    Dengue infection is epidemic but ocular complications of dengue are less reported. We report a case of dengueinfected patient with disturbing ocular symptoms. He was admitted for severe dengue. Subsequently, he presented with symptoms of bilateral central scotoma with metamorphosia. Fundus examination revealed cotton wool spots and flame-shaped haemorrhages at the macula, with dull foveal light reflex. He was diagnosed with bilateral dengue maculopathy. The patient was managed conservatively with surveillance. One week later, his eye symptoms improved and were resolved six months later. Early recognition and close monitoring remains the key to successful management and interventions are rarely needed.
  10. Subramaniam K, Mohd Shah M, Fatin Farisha F, Poh SL, Nor Fadhilah M, Hilmi S
    Med J Malaysia, 2018 10;73(5):272-275.
    PMID: 30350803 MyJurnal
    INTRODUCTION: The role of pathologist not only confined in performing post mortem but also can assist in prevention. The aim of this study to determine the prevalence and association of drug of abuse (DoA) in road traffic collision (RTC) at Hospital Kuala Lumpur.

    METHODS: This is a retrospective study of post mortem cases at Hospital Kuala Lumpur from 2014 to 2016. Deaths from RTC were included while decomposed and homicide cases were excluded. We performed Spearman Correlation statistical test to relate RTC and positive DoA results.

    RESULTS: A total of 523 RTC cases were identified in which either blood or urine or both samples were taken for toxicology. 93 cases were positive for both DoA and therapeutic drugs. A total of 37 cases were positive for DoA. Alcohol was present in 5 out of 37 DoA positive cases. Most of the cases seen among 16 to 45 years old (69%) and predominantly in males (93.1%). 29 out of 37 were motorcyclist and the rest were pillion rider and pedestrian. Spearman Correlation statistical test showed a negative relationship between RTC and positive DoA results.

    DISCUSSION AND CONCLUSION: Majority of the DoA cases in RTC were identified in the younger age group and among the motorcyclist. Spearman Correlation statistical test showed that more cases of DoA died in natural or suicidal manner compared to RTC. However, this doesn't reflect the true association of DoA in RTC. This is because of mainly two factors which the delayed effect of DoA that gives negative toxicology test and also the influence of other road users on DoA.

  11. Wan Rohani WT, Aryati A, Amiratul Athirah S
    Med J Malaysia, 2018 10;73(5):281-285.
    PMID: 30350805 MyJurnal
    INTRODUCTION: The prevalence of overweight and obesity has developed the critical global threat which leads to metabolic risks and mortality. A Leptin hormone that regulates the food intake as well as food expenditure is encoded by Leptin gene. The gene has shown a pivotal role in obesity pathogenesis. This study was sought to determine the SNPs and haplotype association of the Leptin gene that were assigned as G2548A, H1328080, and A19G with obesity among Malays in Terengganu, Malaysia.

    METHODOLOGY: This study comprised of 249 participants (148 overweight/ obese as a case group and 101 lean participants as controls). The PCR-RFLP technique was performed to distinguish the genotype distribution of Leptin gene polymorphisms. The allele and genotype frequencies were assessed for single and haplotype analyses.

    RESULT: Single association analysis of G2548A (P=0.74), A19G (P=0.38), and H1328080 (P=0.56) polymorphisms yielded no statistically significant association. However, haplotype association analysis showed a suggestive indication of AAG haplotype (G2548A, H1328080, and A19G sequence) with susceptibility effect towards obesity predisposition [P=0.002, OR=8.897 (1.59-9.78)].

    CONCLUSION: This data on single and haplotype might disclose the preliminary exposure and pave the way for the obesity development with an evidence of revealed susceptibility to obesity.

  12. Tang IP, Ling XN, Prepageran N
    Med J Malaysia, 2018 10;73(5):276-280.
    PMID: 30350804 MyJurnal
    OBJECTIVES: To investigate the surgical and audiological outcome of Bonebridge (BB) at tertiary centres in Malaysia.

    STUDY DESIGN: Prospective, intra-subject repeated measurements of which each subject is his/her own control, from year 2012 to 2016 at two tertiary referral centres.

    METHODS: Twenty patients with hearing loss who fulfilled criteria for BB and showed good response to bone conduction hearing aid trial were included. Implantations of BB were carried out under general anaesthesia with preoperative computed tomography (CT) planning. Complications were monitored up to six months postoperatively. Subjects' audiometric thresholds for air conduction, bone conduction and sound field at frequencies of 250Hz to 8kHz were assessed preoperatively and at six months postoperatively. Subjects' satisfaction was evaluated at 6 months post operatively with Hearing Device Satisfaction Scale (HDSS) questionnaire.

    RESULTS: There was no major complication reported. Mean aided sound field thresholds showed significant improvement for more than 30dB from 500 to 4000kHz (p<0.05). There was no significant change in mean unaided air conduction and bone conduction thresholds pre and post operatively from 500 to 4000kHz, with a difference of less than 5dB (p>0.05). All the patients were very satisfied (>80%) with the implant, attributing to the promising functional outcome and acceptable cosmetic appearance.

    CONCLUSIONS: BB implantation surgery is safe and is effective in restoring hearing deficits among patients aged five and above with conductive or mixed hearing loss and single-sided hearing loss.

  13. Syahnaz MH, Rasina Nilofer JK, Azmawati MW, Harlina Halizah S
    Med J Malaysia, 2018 10;73(5):301-306.
    PMID: 30350809 MyJurnal
    BACKGROUND: The practice of modern contraceptives still remains a sceptical issue in the society and dormant due to increasing objection of husbands who play a significant role in the family planning practice.
    OBJECTIVES: This study was done to determine the factors affecting the ever use of modern contraceptive methods among married men visiting a healthcare clinic in Malaysia.
    MATERIAL AND METHOD: A cross sectional study of 443 men aged over 18 years was conducted using convenient sampling from January 2016 till March 2016 at a primary care clinic. A self-administered questionnaire assessing sociodemographic characteristic, attitude towards family planning, spousal communication and ever used of modern contraceptive methods was used.
    RESULTS: The proportion of ever used modern contraception was 48% (n=192). Multiple logistic regression revealed that spousal communication on family planning (Adjusted OR 15.8; 95% CI 7.0 - 35.6) and attitude towards marital relationship (Adjusted OR 1.1; CI 1.0 - 1.1) were significant predictors for ever used of modern contraception among married men.
    CONCLUSION: The proportion of ever used modern contraception is still not high. Men who communicated with their spouse on modern contraception and perceived family planning as means to preserve their marital relationship were more likely to practice modern contraceptive method.
    Study site: Klinik Kesihatan, Selangor, Malaysia
  14. Liew KW, Siti Zubaidah S, Doreen L
    Med J Malaysia, 2018 10;73(5):297-300.
    PMID: 30350808 MyJurnal
    BACKGROUND: Malignant phyllodes tumors of the breast are uncommon fibroepithelial breast tumors with diverse biological behavior. Our study aim is to share our experience in treating patients with malignant phyllodes presenting to our center.

    PATIENTS AND METHODS: A total of 11 cases of malignant phyllodes were retrospectively reviewed between Nov 2014 and Oct 2017.

    RESULTS: The median age was 45 years old (31- 61 years). The median pathological tumor size was 10.5cm (2-28cm). 6 patients (55%) were premenopausal. 7 patients (64%) were treated eventually with mastectomy and 4 (36%) were treated with breast conserving surgery. 4 (36%) patients had Axillary Clearance done while axillary sampling was done in 2 patient. The remainder 5 (45%) required axillary clearance at a later op. 6 (55%) patients received postoperative radiotherapy. After a median follow up period of 11 months (range 4-33 months), 8 developed local recurrence. The overall 2 year survival rate was 18%.

    CONCLUSION: Malignant Phyllodes tumors are rare tumors that occur in fairly young women, when compared with the adenocarcinoma of the breast. They tend to grow to reach large with absence of nodal metastasis. Ultimately surgery is the mainstay of management but with postoperative radiotherapy it can decrease the local recurrence rates in certain presentations however recurrence rate is high and overall survival rates are poor.

  15. Nirwati H, Hakim MS, Darma S, Mustafa M, Nuryastuti T
    Med J Malaysia, 2018 10;73(5):291-296.
    PMID: 30350807
    INTRODUCTION: Acinetobacter baumannii (A. baumannii) is commonly found as an agent of nosocomial infections and demonstrates a high antibiotic resistance due to its carbapenemase production. The objectives of this study were to explore the antibiotic resistance pattern, the presence of OXAs genes and the biofilm-producing capacity of A. baumannii isolated from clinical specimens.

    METHODS: Antibiotics susceptibility testing, detection of OXAs genes and the biofilm-producing capacity were performed using the Kirby Bauer method, polymerase chain reaction (PCR) and adherence quantitative assays, respectively.

    RESULTS: A total of 80 A. baumannii isolates were mainly obtained from sputum and most of them were resistant to antibiotics. All A. baumannii carried blaOXA-51 gene, yet no blaOXA-24 and blaOXA-58 genes were detected. Fourteen (82.4%) of the 17 meropenem resistant isolates carried blaOXA-23 gene, but it was not found in meropenem sensitive isolates. In addition, sixty (75.0%) of 80 isolates were biofilm producers with 2 (2.5%), 16 (20.0%), and 42 (52.5%) isolates were identified as strong, moderate and weak biofilm producers, respectively.

    CONCLUSION: Most of A. baumannii isolates had a high level of antibiotic resistance and had a capacity to produce biofilm.

  16. Ismail NA, Ragab S, Abd El Dayem SM, Baky ANAE, Hamed M, Ahmed Kamel S, et al.
    Med J Malaysia, 2018 10;73(5):286-290.
    PMID: 30350806
    INTRODUCTION: CDKAL1 single-nucleotide polymorphism rs 9465871variant is a risk locus for Type 2 Diabetes (T2DM).The study evaluated the associations of CDKAL1- rs9465871 with glycosylated hemoglobin A1C Level (HbA1c), fasting insulin level, insulin resistance and metabolic syndrome among obese and non- obese Egyptian children.

    MATERIALS AND METHODS: The study included 43 obese children and 40 normal weight children. Anthropometric body measurements, bio-specimen and biochemistry assays were done. Genotyping of rs9465871 (CDKAL1) was conducted.

    RESULTS: The percentages of the CC, CT, and TT genotypes of rs9465871in the lean children were 15%, 42.5%, and 42.5%, respectively. Regarding obese children, the frequencies were 18.6%, 58.1% and 23.3% respectively with no significant statistical difference. Comparison between the CDKAL1 rs 9465871 polymorphism showed that the highest value of fasting insulin was recorded in CC genotype (22.80± 15.18 [uIU/mL] P

  17. Zakuan ZD, Suresh K
    Med J Malaysia, 2018 10;73(5):351-359.
    PMID: 30350826 MyJurnal
    Polymyxin B and colistin (polymyxin E) were introduced in clinical practice to treat Gram-negative infections in 1950s but their parenteral use waned in 1970s due to toxicity concerns. Resurgence of polymyxins use in Malaysia began approximately in 2009 due to a lack of treatment options for MDR Gram negative superbugs such as Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. However, limited experience and a lack of widespread availability of up-to-date dosing guidelines could potentially result in incorrect use of these last resort antibiotics by managing doctors. The recent report of polymyxin resistant strains is also a cause of concern. Herein, we discuss the importance of preserving the efficacy of polymyxins in hospitals, the similarities and differences between polymyxin B and colistin, issues pertaining to current use of polymxyins and strategies to improve polymyxins' prescription. Polymyxins should only be used to treat significant infections, in optimum doses and if possible, in combination with other antibiotics.
  18. Nurul Anis MY, Normah CD, Mahadir A, Norhayati I, Rogayah AR, Dzalani H
    Med J Malaysia, 2018 10;73(5):311-320.
    PMID: 30350811 MyJurnal
    INTRODUCTION: Dyslexia is a neurobiological impairment that primarily affects reading ability. It is commonly known as a reading disorder which is likely to be present at birth and is generally identified at pre-school level. Dyslexia is manifested through difficulties with accurate word recognition and also by poor performance in reading and writing.

    METHOD: The main objective of this paper is to review the various methods or treatments that are used to manage the literacy and cognitive abilities for children with dyslexia particularly in Malaysia. The articles were obtained from online databases such as PubMed, Ebscohost and Medline during the time frame of six years starting from 2000 until 2016. An initial count of 300 articles were generated but only 13 articles met the inclusive criteria.

    RESULTS: There are a few types of interventions such as the multisensory method, the phonological intervention, and the cognitive training method which can be used to improve literacy and cognitive deficits among children with dyslexia. In Malaysia, most of the treatments are focused on the aspects of language such as word mastery, alphabet identification and writing skills. The cognitive training were carried out to improve specific domain such as visuospatial skills, memory skills and psychomotor skills.

    CONCLUSION: There is yet no studies which has employed the comprehensive method of combining the intervention of cognitive functions and linguistics-literacy deficits. It is imperative that researchers in Malaysia go beyond literacy skills and take into consideration the underlying cognitive functions which contribute to the specific reading and writing difficulties of Malaysian children with dyslexia.
  19. Wan Rohani WT, Mahfudzah A, Nazihah MY, Tan HL, Wan Syamimee WG, Amanda Jane PG, et al.
    Med J Malaysia, 2018 10;73(5):307-310.
    PMID: 30350810 MyJurnal
    INTRODUCTION: Gout is one of the most common inflammatory arthritis in Malaysia. It is due to persistent hyperuricemia that leads to the formation and deposition of intra- and periarticular monosodium urate crystals either due to excessive production or insufficient excretion of uric acid. Incidence and prevalence of gout is increasing worldwide, with a higher rate among men compared to women. Malay is the largest ethnic group in Malaysia, followed by Chinese and Indian. SLC2A9 is a renal urate transporter that controls renal uric acid excretion and genetic variants in SLC2A9 are associated with the risk of gout in several populations. This study aimed to test if the SLC2A9 variant (R265H, rs3733591) is also associated with gout among Malays in Malaysia.

    METHODOLOGY: A total of 89 patients with gouty arthritis and 100 normal subjects who consented and were recruited in this study. The serum urate and creatinine were measured. The SNP genotyping was performed using PCR-RFLP method for rs3733591 and BST 1236 was used as a restriction enzyme to cut the targeted amplicons.

    RESULT: SLC2A9 variant was associated with gout, p-value of 0.007, OR=4.713 [95%CI 1.530-14.513], however this association was not significant after adjustment for age and gender with p=0.465 (OR=1.950; 95%CI[0.325-11.718]).

    CONCLUSION: Our data suggest that the genetic variant of SLC2A9 may contribute to the susceptibility of gout among Malays in Malaysia.

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