Normally endometrial carcinoma presents with post-menopausal bleeding in the majority of cases. It
rarely presents with haematometra. If it does, it rarely reaches the term pregnant uterus size. This case
report is a rare presentation of endometrial carcinoma which was at first diagnosed as a huge ovarian
mass later found out to be haematometra intraoperatively. There was a discordant finding between the
endometrial invasions with distant metastasis (Local invasion of stage 1A with lung metastasis which
should be stage 4B). It is an uncommon combined occurrence but at least we learnt there can be possible
different presentation for endometrial cancer. It further proved that almost all of haematometra can turn
out to be associated with endometrial carcinoma.
Infectious disease remains a public health concern in Malaysia. Efficient public health infectious disease surveillance is needed in order to address the issues posed by infectious disease. The main goal of public health infectious disease surveillance is to facilitate the control and prevention of the infectious diseases. For that, infectious disease surveillance needs involvement of multidiscipline either in government or non-government/private to ensure its success. General practitioners (GPs) have an important role in public health infectious disease surveillance considering their role and position as one of the main front liner medical personnel.
Ovarian cancer is the fourth most common cancer among women in Peninsular Malaysia. Epithelial ovarian cancer accounts for 90% of all ovarian tumours. Herein, we present a rapidly growing ovarian tumour in a young female patient, following an uneventful vaginal delivery at home. We discuss on the challenges of making said diagnosis in a post-partum patient who presented with abdomen distension. A 19-yearold lady presented to the Emergency Department three days after spontaneous vaginal delivery at home. Her chief complaint was that of a rapidly progressive abdominal distension. Diagnostic and therapeutic emergency laparotomy were done, revealing a huge cystic ovarian mass. Histopathology reported a high grade, serous ovarian carcinoma. There are multiple causes for abdominal distension in post-partum women, however priority should be given into looking for gynaecological origin, given the changes in hormone. Sudden abdominal distension during post-partum period is rare and a systemic approach in its management is vital. There is, inarguably, a role of diagnostic and therapeutic laparotomy in this.
Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity among teenager. For those indicated, early surgical intervention allows better surgical correction due to flexibility of the spine during teenage years, hence good functional outcome and better cosmetic can be expected. In this case report, there is the management of four patients surgically using the posterior spinal instrumentation and fusion. Pre-operatively patients were examined at IIUM Medical Centre spine clinic, all necessary investigations were carried out. A thorough explanation was done to patient and parents regarding procedure, risk and benefit. All patients were treated using the same surgical technique. Neuromonitoring was used throughout the whole surgery until skin closure. All patients were hospitalized around one week. Post-operatively patients were followed up at two weeks, six weeks, three months, and every six months thereafter. It is important for clinicians to identify patients with AIS as early detection and timely treatment will change the natural history of curve progression. Surgical intervention when necessary will be easier and with less risk of complications when surgery was carried out during teenage years as the spine is more flexible and the deformity is less severe.
Prostate carcinoma is a common health issue that can metastasise in the spine. A 65-year-old male was diagnosed with prostate carcinoma and two years later he developed a progressive neurological deficit over the bilateral lower limb. He experienced severe back pain, became paraplegic and the quality of life was severely impaired. Radiographic investigations were done and revealed osteoblastic bone metastasis at thoracic vertebrae with spinal cord compression. The patient underwent surgical decompression surgery at the T9 level mainly for pain control. Six months post-surgery not only the pain was well controlled but patient able to ambulate with walking aid. It is a rare post-operative result as the neurological recovery in a patient with complete paralysis is less than 3%. This type of recovery is possible when the cause of the neurological deficit is mainly mechanical compression from tumour rather than cord ischaemia from traumatic injury.
Tuberculosis (TB) is an ancient disease dated back from ancient Greece time. Once rare in developed countries, now it has re-emerged due to immigration and secondary immunodeficiency. A 27-year-old lady had left knee pain for the past 4 years, went for knee diagnostic arthroscopy procedure, and diagnosed as pigmented villonodular synovitis (PVNS) of the left knee. Despite regular analgesics and physiotherapy, patient symptoms worsen. Two years after the initial treatment, the patient went for a further workout and diagnosed as knee tuberculosis, commenced on anti-TB treatment, the patient still left complicated with a stiff knee and fixed flexion deformity. Identification of knee tuberculosis during the initial phase is crucial as late diagnosis and treatment will leave the patient with debilitating complications.
Galactorrhoea is non-lactational milk production and it may or may not be associated with prolactinemia1. It causes embarrassment and distress to a schizophrenic patient, especially, if the patient is male. One study in Germany reported that incidence and prevalence of galactorrhoea in schizophrenia are 14% and 19%, respectively2. Although galactorrhoea is not rare in schizophrenic patients, managing and understanding the a etiology can be problematic. In psychiatric patients, antipsychotics can be a cause but other causes need to be ruled out. Galactorrhoea also needs to be differentiated from pathologic nipple discharge which can be due to breast tumours. Usually, galactorrhoea is bilateral, multiductal, and milky, but discharge can be yellow, green or brown3. This case report describes a 32-year old patient with schizophrenia who visited a government psychiatric hospital in Kota Kinabalu, Sabah, Malaysia. This report highlights the clinical challenges to determine the aetiology of galactorrhoea and to manage it in schizophrenics. It raises the following clinical questions: Why a psychiatric patient develops galactorrhoea? How a schizophrenic patient presents with galactorrhoea? What hormonal imbalances are associated with this psychiatric disorder? How should a doctor handle a schizophrenic patient complaining of galactorrhoea? What is the danger of having galactorrhoea in a male?
Slum children are at risk for serious mental health problems because of their economic and social
environments. Little is known about their mental health. This cross sectional study was carried out to
know the extent of mental health problems among slum-dweller children in Dhaka city, Bangladesh. One
hundred and twenty students of four different primary schools were selected. In the first stage of the study,
socio-demographic data as well as information about mental health problems were collected through
socio-demographic questionnaire and validated Bengali version of Rutter B2 scale respectively, from the
teachers of the schools. In the second stage, all the students were assessed again personally by the both
authors with the help of Diagnostic and Statistical Manual of Mental Disorders- fourth edition (DSMIV).
High prevalence of mental health problems was found among slum children (70.8%). Emotional,
conduct and undifferentiated disorders were detected in 14.17%, 45.83% and 10.83%, respectively.
Conduct disorder was 3.23 times more prevalent in the children than was emotional disorder. It was more
prevalent in boys than in girls (57.90% vs 34.90%). Significant relationships were found among gender
and emotional disorder (p < 0.030), father’s employment status and undifferentiated disorder (p < 0.010),
substance abuse by father and child’s emotional disorder(p
PHC services particularly the ambulance call is traditionally a hospital-based system. Within the Kota Kinabalu area, there are 3 tertiary hospitals that provide the ambulance call service; and also provide the interfacility transfer, disaster management and medical team standby. How about the health clinics? Health clinics play a major role for primary healthcare and the interfacility transfer of patient from the health clinics to the hospital.
Cigarette smoking is considered as the symbol of adulthood and as a friend during stress and loneliness. The developing countries in South Asia where the largest segment of the population is comprised of adolescents are more susceptible to smoking epidemic and its consequences. A cross sectional survey among 304 randomly selected medical students was carried out to determine their smoking habit of a selected medical college in Dhaka, from 1st October to 31st December 2014. The respondents were from 16 to 20 years of age, with mean (±SD) of 16.8 (±1.9) years. Among them (including 28 girl students), 96(31.5%) were non-smokers. The remaining 208(68.4%) were smokers, among them 43(20.6%) were regular smokers, and 165(79.3%) were occasional smokers. All 28 female students were non-smokers. Regarding duration of smoking, 42(20.2%) respondents smoked for less than 6 months, 64(30.8%) for 6 months to 1 year, 88(42.3%) for 1 to 4 years, 11(5.3%) for 5 to 10 years and a least 3(1.4%) smoked for more than 10 years. Thirty six percent of current smokers smoked more than 10 sticks per day compared
with thirty percent who smoked 6 to 10 a day. Significantly more users knew that it causes tuberculosis, heart attack, cancer and development of hypertension. Overall, students’ major sources of information were doctors (69.7%), medias (47.7%), parents (9.2%) and friends (3.3%). As the prevalence of smoking among medical students was found very high hence, the multi-pronged intervention strategy is needed to tackle the problem. Anti-tobacco education and awareness should be adopted in the curriculum of schools and colleges. All forms of tobacco advertising and promotional activities should be banned, and parents should be encouraged to adopt more responsible attitudes toward smoking in the home.
“If you hear of an outbreak of plague in a land, do not enter it; if the plague breaks out in a place while you are in it, do not leave that place”, reported by Sahih Al-Bukhari. This was the phrase quoted by Prophet Muhammad 14 centuries ago concerning both in disease spread and prevention. The relevancy of this statement is now widely seen and surge by the social media in a hashtag of “stay home” on an international level due to pandemic of COVID-19 disease.
Fracture is common after trauma. Proximal humeral fracture can occur in the elderly after fall and in youngsters after motor vehicle accidents (MVA) and sport injuries. A 37-year-old man was admitted with a fracture of his left proximal humerus following an MVA. He sustained a 3-part fracture and treated surgically using a PHILOS plate. There are few options in managing proximal humerus fracture ranging from conservative to surgical intervention based on its severity. We reminiscent the usage of PHILOS plate as a mode of treatment of such fracture.
Fat embolism syndrome is manifested by the fat globule presence in the pulmonary and systemic circulation. A 34-year-old man was involved in a motor vehicle accident with a fracture of the left femur and avulsion fracture of the left posterior cruciate ligaments. He developed signs and symptoms that suggested an early diagnosis of fat embolism syndrome. Intravenous methylprednisolone administration was administered as part of the treatment. The role of methylprednisolone in a patient with fat embolism syndrome is controversial due to unproven effectiveness. In this case, fat embolism syndrome after a femur fracture was treated successfully with methylprednisolone.
The Emergency Department (ED) provides treatment for acutely ill patients in need of urgent medical attention. Despite the availability of the primary care unit ‘Klinik Kesihatan’, where non urgent patients should be treated, Malaysia’s public hospitals still need to deal with overcrowding of non-urgent patients in ED. The main aim of the study was to assess the willingness of non-urgent patients to be redirected to Klinik Kesihatan. This was a cross-sectional study conducted at Hospital Tuaran Emergency Department, Sabah. Non-urgent patients were interviewed using a questionnaire, to find out the purpose of their visit to Emergency Department. A total of 318 non-urgent patients out of 457 patients were interviewed during the study duration. 41 respondents (12.9%) were willing to be redirected towards a Klinik Kesihatan. No associated factors were found when compared with the unwilling to be redirected group. Among 277 respondents who rejected redirection to Klinik Kesihatan, 70.4% agreed to pay a surcharge to be treated in the Emergency Department and there was no association found with the employment status (p= 0.391). Most patients were not willing to accept redirection to a Klinik Kesihatan and would prefer to visit the Emergency Department despite knowing that their condition or illness is one that does not require emergency treatment. Social media, advertisements and pamphlets must be made available to educate patients on the proper use of the Emergency Department.
Pain management with analgaesics employs a multidisciplinary approach of clinicians towards patients. Nevertheless, preventing drug abuse and misuse in pain management is also an important goal. Understanding patients’ behaviour in the usage of painkillers may facilitate more effective communication and to educate them on the appropriate choice of painkillers. This study aimed to assess patients’ knowledge, attitude and practice towards painkillers. This was a questionnaire-based cross-sectional study conducted from February to May 2016 among patients in Tawau Hospital. Respondents were selected via convenience sampling and interviewed based on a questionnaire to assess their knowledge, attitude and practice towards painkillers. A total of 193 questionnaires with complete responses were analysed. Most of the respondents
(60.1%) obtained their painkillers from public facilities. Generally, they were very satisfied with the painkillers that they had used (36.7%). However, most of them (75.0%) did not know the name of the ingredient of the painkillers that they had taken before. They were also not aware of the side effects (73.1%) and allergic reactions (64.8%) caused by painkillers. Most of the respondents (58.5%) had not been informed regarding the side effects of the painkillers by healthcare professionals. Only 25.0% of the respondents had been asked regarding their past medical history, past medication history and allergic history by healthcare professionals before a painkiller was recommended to them. This study highlights the need of continuous efforts by healthcare professionals to inform patients of the proper use and risks associated with painkillers to improve the quality use of painkillers.
Irrational use of drugs could be detrimental issues in the practices of healthcare communities. This problem arises either because of the wrong prescription or inappropriate self-medication. Faulty prescribing practices and incorrect self-medication will lead to an ineffective treatment regime. Still, they can also be unsafe as these may exacerbate or prolong the illness and distress the patients. In turn, these will incur unnecessary treatment costs. The most typical issues in the irrational use of drugs are the patient’s lack of information about the medicine and inadequate proper consultation from physicians. Lack of regulation in the appropriate use and supply of drugs by the relevant enforcement agencies could also be the problem in the irrational use of drugs. Ulceration and inflammation due to the irrational use of NSAIDs, antibiotics, and unhealthy lifestyle may contribute to the novel therapeutic strategy challenges. The ability to purchase the drugs without a doctor’s prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) was also the landmark event that became the most widely used medications for the anti-inflammatory, analgesic, and antipyretic effects. Inadequate knowledge from both drug providers and patients may contribute to the most recognized influential factors in the irrational use of drugs in various countries. The recommendation should introduce an appropriate educational intervention that can be designed to promote rational prescribing. Proper regulation on prescription practices by policymakers and physicians could be the way to ensure the standard of rational usage of drugs have compliant with the healthcare communities.
Contralateral hyperhidrosis from the cardiovascular accident has been infrequently described in the stroke literature. The clinical significance and pathogenesis are yet well understood. This is a case of a 60-year-old man who developed excessive sweating of the paralyzed side with a pure division along the midline of the body secondary to a subcortical stroke, which region is supplied by branches of middle cerebral artery territory known as deep perforating lenticulostriate. To the best of our knowledge, a precise clinicoanatomic correlation between hyperhidrosis and subcortical stroke has not been widely reported. In this review, we summarize the existing literature of post-stroke hyperhidrosis to evaluate the correlation between clinical manifestation and its neuroanatomical location. According to the location of the infarction and clinical features, it can be concluded that both tracks en route through the ipsilateral internal capsule, after originating in the opercular cortex before crossing the brain stem and terminal connections with the contralateral thoracic spinal cord. Therefore, the phenomenon of hyperhidrosis in anterior circulation stroke might be postulated as due to the disruption of the sympathoinhibitory pathway that controls sweat glands, similarly like posterior circulation stroke.
This systematic review was aimed to evaluate the effectiveness of technology-enhanced learning (TEL) used in medical teaching for undergraduate medical students. The objectives are to (a) identify various teaching modalities which are used to enhance TEL; (b) evaluate whether TEL is more effective than traditional learning (TL) in cognitive and affective learning domain outcome. The empirical studies were searched in the following databases: Google Scholar, MEDLINE, ERIC, ProQuest, Cochrane Library and Scopus. All papers published from 2008 to 2018 were included. From eligible studies, the study design, study field, study population, intervention methods, type of assessment and learning achievement were abstracted and summarized the information. The search results were independently reviewed by two authors. From a pool of 1384 articles, 43 eligible articles were identified, enrolling 7292 undergraduate medical students examining comparative study between TEL and traditional learning. The results showed that there was a high degree of heterogeneity seen amongst the included studies in terms of TEL modalities used. The majority of intervention studies favoured online resources, while the rest used various offline multimedia electronic devices, virtual simulations and blended modes. Overall findings showed promising data that TEL is better than TL with regards to knowledge gain and skill acquisition, as well as providing higher student satisfaction. In all, the findings present blended learning in a positive and promising light in time, particularly where systematic reviews on technology-enhanced learning in the field of the undergraduate medical programme have produced mixed result.REVIEW ARTICLEA Systematic Literature Review on Technology-Enhanced Learning in Medical EducationMay Honey Ohn1*, Bareth Ravindran2, Chan Zhi Wei3, Khin Maung Ohn4, Ng Pey Luen5Borneo Journal of Medical Sciences 14 (1) January, 2020: 3 – 171 Emergency Department, Sandwell & West Birmingham NHS Trust, United Kingdom2 Surgical Department, Hospital Tuanku Ja’afar Seremban, Kuala Lumpur, Malaysia3 Orthopaedics Department, Hospital Sungai Buloh, Kuala Lumpur, Malaysia4 Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia5 Radiology Department, Hospital Queen Elizabeth II, Sabah, Malaysia* Corresponding author’s email: mayhoney.ohn@gmail.com Received: 14 July 2019 Accepted: 5 November 2019Borneo Journal of Medical SciencesBJMSKeywords: blended learning, technology-enhanced learning, medical education, hybrid learning, undergraduate medical students
Melioidosis an infectious disease caused by gram-negative bacteria, Burkholderia pseudomallei is highly endemic in Malaysia, Thailand, Singapore and parts of northern Australia. The district of Tuaran which is located on the west coast of Sabah had reported an increasing trend of Melioidosis cases where in 2017, a total of 19 cases were reported, more than doubling the number of cases reported the prior year (7 cases).