MyMedR

Zaki M

Med J Malaysia, 1995 May;50 Suppl A:S29-32.

Sharifah MI, Noryati M, Che Zubaidah CD, Zakaria Z

Med J Malaysia, 2010 Jun;65(2):150-1.

Foetus-in-fetu is a rare condition in which a calcified mass is in the abdomen of its host, a newborn or an infant. We report a case of a newborn in whom abdominal radiograph and ultrasonography revealed a mass in which the contents favour a foetus-in-fetu. Diagnosis was confirmed by macroscopic examination that showed a soft tissue mass resembling a foetus, attached to the membranous sac. It was covered entirely with intact skin. There were two malformed lower limbs with a rudimentary digit and one malformed upper limb.

A 10-year systematic review and meta-analysis of determinants of postpartum depression in the Association of Southeast Asian Nations countries

Sainuddin SS, Norhayati MN, Abdul Kadir A, Zakaria R

Med J Malaysia, 2023 Sep;78(5):675-686.

PMID: 37775497

INTRODUCTION: Postpartum depression (PPD) is a mental and emotional condition that can affect women during their first postnatal year and concern globally. This study aimed to determine the overall prevalence and determinants of postpartum depression (PPD) in Association of Southeast Asian Nations (ASEAN) countries.

MATERIALS AND METHODS: A systematic search of observational studies conducted in ASEAN countries between 1 January 2010 and 31 December 2020 was performed in the Medline, PubMed and Google Scholar databases. The quality of studies was evaluated based on The Joanna Briggs Institute Checklist. The analysis was performed with Review Manager software version 5.4. Metaanalysis of the estimates from primary studies was conducted by adjusting for possible publication bias and heterogeneity.

RESULTS: Twenty-five studies including 19924 postnatal mothers were included in this review. The pooled prevalence of PPD is 22.32% (95% CI: 18.48, 26.17). Thailand has the highest prevalence of PPD with a pooled prevalence of 74.1% (95% CI: 64.79, 83.41). The prevalence of PPD was highest when the assessment for PPD was conducted up to 6 weeks postpartum with a pooled prevalence of 25.24% (95% CI: 14.08, 36.41). The identified determinants of PPD were unplanned pregnancy, term pregnancy, lack of family support and physical violence. There were limited studies done and high heterogeneity in terms of quality, methodology, culture, screening method and time of PPD measurement.

CONCLUSIONS: Approximately one in five postpartum women in ASEAN countries had PPD. The risk factor that lowers the risk of PPD is unplanned and term pregnancies, while women with a lack of family support and experienced physical violence increase the risk of PPD. Robust prevalence studies are needed to assess the magnitude of this problem in ASEAN countries.

Achalasia cardia: A five-year review in Hospital Tuanku Ja'afar, Seremban

Chin DHJ, Lim KG, Peh HS, Burud IAS, Tata MD, Zakaria J

Med J Malaysia, 2022 Jan;77(1):41-46.

PMID: 35086993

INTRODUCTION: Achalasia cardia is an oesophageal motility disorder that affects various age groups. This study focused on the epidemiological features of achalasia, its risk factors, treatment modalities offered and the clinical outcomes in a tertiary hospital.

MATERIALS AND METHODS: A retrospective search was carried out on all patients with a diagnosis of achalasia cardia in Hospital Tuanku Ja'afar (HTJ), Seremban, Malaysia between 2014 and 2018. Demographic data, patient symptomatology, and definitive management options were determined from the records. Telephone interviews were conducted to evaluate patient satisfaction with the outcome of treatment.

RESULTS: There were 30 patients with a newly diagnosed achalasia cardia in that 5-year period, with an equal incidence among men and women. The mean age of presentation was 44.63 ± 18.21 years. Malays formed the largest group. The mean weight and body mass index were 46.8 ± 10.4 kg and 18.0 ± 4.4 kg/m2 respectively. There was a wide range of duration of symptoms at presentation with a mean of 30.11 ± 35.29 months. Almost all patients presented with dysphagia (96.7%) while 70% also noted loss of weight. All patients underwent oesophagogastroduodenoscopy (OGDS) and 26 patients (86.7%) had barium swallow as part of diagnostic workup. A total of 18 patients underwent a laparoscopic Heller myotomy with or without Dor Fundoplication and/or cruroplasty while two patients (6.7%) underwent pneumatic dilatation as first treatment. Iatrogenic mucosal perforations were detected in 8 patients who underwent myotomy and fundoplication and were repaired intraoperatively. Of the patients who underwent myotomy and fundoplication, the mean weight increase was 15.6kg, increasing from 43.0 ± 8.4 kg to 58.6 ± 13.7 kg. All the patients who underwent treatment were satisfied with their treatment outcomes.

CONCLUSION: Most patients with achalasia cardia deemed suitable for surgery and counselled accordingly accept surgery resulting in high levels of satisfaction and weight gain in almost all these patients. A small minority who opt for pneumatic dilatation may also achieve satisfactory outcomes comparable to surgery in the short term. Although rare, clinicians should be able to recognise this disease early as early intervention often leads to satisfactory longterm outcomes.

Fulltext Radiation exposure to the surgeon during femoral interlocking nailing under fluoroscopic imaging

Muzaffar TST, Imran Y, Iskandar MA, Zakaria A

Med J Malaysia, 2005 Jul;60 Suppl C:26-9.

PMID: 16381279

Femoral interlocking nailing requires fluoroscopic assistance for insertion of the nail and distal screws. In this study, scattered radiation to the eye and hand of the operating surgeon was measured during the procedure. Thermo-luminescent dosimeter (TLD) was used to quantify the dose received by the surgeon. The mean radiation exposure time during the procedure was 3.89 minutes. The mean scattered radiation doses to the hand and eye were 0.27 mSv and 0.09 mSv per procedure respectively. These very low doses have made a surgeon very unlikely to receive more than the recommended annual dose limit set by the National Council on Radiological Protection.

Fulltext Cross-sectional study of older adults with type 2 diabetes mellitus in two rural public primary healthcare facilities in Malaysia

Ooi CP, Loke SC, Zaiton A, Tengku-Aizan H, Zaitun Y

Med J Malaysia, 2011 Jun;66(2):108-12.

PMID: 22106688 MyJurnal

Knowledge of the characteristics of older adults with type 2 diabetes mellitus (T2DM) is indispensible for improvement of their care. A cross-sectional study in two rural public primary healthcare centres in Malaysia identified 170 actively engaged older patients with T2DM, with suboptimal glycaemic control and frequent hypoglycaemia. The prevalence of multiple co-morbidities, complications of T2DM, high cardiovascular risk, neurological, musculoskeletal and visual deficits suggested high risk of disabilities and dependency but not yet disabled. This short window for interventions presents as an opportunity for development of a more comprehensive approach extending beyond glycaemia control to risk management, preventing functional loss and continuity of social participation.
Study site: Klinik Kesihatan, Selangor, Malaysia

Fulltext Pattern of occupational allergic dermatitis in the Dermatology Clinic, Hospital Kuala Lumpur

Rohna R, Ganesapillai T, Salbiah D, Zaiton I

Med J Malaysia, 1999 Mar;54(1):128-31.

PMID: 10972018

A two years retrospective analysis of patients diagnosed as contact allergic dermatitis with positive patch test attending the Dermatology clinic was performed. Of the 346 patients with a positive patch test, 14% had occupational dermatitis. This condition affected mainly young and inexperienced workers. An inverse relationship was seen between age and prevalence of occupational allergic dermatitis. Allergic hand dermatitis was the commonest presentation in occupational allergic dermatitis. This was followed by dermatitis of the exposed skin (face, neck, hands and forearms). The common sensitising agents identified were rubber chemicals and nickel. The two main groups at risk were factory workers and medical personnel. The common allergens found in factory workers were epoxy resin, pewter, nickel and rubber chemicals. Exposure dermatitis occurred in patients working in the pewter industry. Two thirds of medical personnel with hand dermatitis were allergic to rubber gloves. One year follow up after patch testing showed that 19% of patients still suffered from chronic dermatitis. Dermatitis improved in 34% of patients. Forty-seven percent were cured and stopped attending the clinic after patch testing and adequate counselling.

Study site: Dermatology Clinic, Hospital Kuala Lumpur

Fulltext Ethnic differences in glycaemic control and complications: the adult diabetes control and management (ADCM), Malaysia

Chew BH, Mastura I, Lee PY, Wahyu TS, Cheong AT, Zaiton A

Med J Malaysia, 2011 Aug;66(3):244-8.

PMID: 22111449 MyJurnal

Ethnicity is an important factor in diabetes care. The understanding of its effect in this country may help to improve diabetes care, glycaemic control and diabetic complication rates. This study was to determine the diabetes control profile in relation to complication rates between the three main ethnics group in Malaysia.

Fulltext Incidence of Listeria spp. in vegetables in Kuala Lumpur

Tang MY, Cheong YM, Zainuldin T

Med J Malaysia, 1994 Sep;49(3):217-22.

PMID: 7845269

From April 1992 to September 1992, 280 samples of 10 different fresh vegetables, bought from four different market outlets in Kuala Lumpur were examined for the presence of Listeria spp. Most of the market produce were locally grown with the exception of carrots. The isolation procedure was based on the Food & Drug Administration method (modified) used for the detection of Listeria spp. Isolation media used were Listeria Selective medium and LiCl- phenylethanol-Moxalactam agars. The identification of isolates was by means of conventional biochemical tests and API Listeria identification system. Five out of the 280 samples showed Listeria contamination, Listeria monocytogenes was isolated in lettuce, sengkuang (Pachyrrhizus erosus) and selom Oenanthe javanica) and Listeria innocua was isolated from sengkuang (Pachyrrhizus erosus) and pegaga (Hydrocotyle asiatica).

Fulltext The empty follicle syndrome

Ng SP, Jamil MA, Nurshaireen A, Zainul MR

Med J Malaysia, 2006 Oct;61(4):499-500.

PMID: 17243533 MyJurnal

The empty follicle syndrome (EFS) is a rare complication of in vitro fertilization (IVF) treatment, leading to cycle cancellation. Low human chorionic gonadotropin (hCG) bioavailability and ovarian dysfunction have been implicated with this condition. This case report illustrates a typical case of EFS and several strategies suggested to overcome this problem.

Neonatal aortic thrombosis: A life threatening complication of umbilical artery catheterisation

Thay WY, Aisha Fadhilah AA, Faizah MJ, Zainudin Z

Med J Malaysia, 2020 03;75(2):173-174.

PMID: 32281603

Umbilical artery catheterisation is considered the standard of care for arterial access in neonatal intensive care unit. It is routinely used for blood sampling and blood pressure monitoring. Unfortunately, an indwelling umbilical catheter have been associated with thrombotic complication which may result in either partial or complete occlusion of the aorta. We report here our experience in the diagnosis and treatment of a neonate with this condition.

Fulltext Ultrasound guided percutaneous biopsies of suspected mediastinal lesions

Samad SA, Sharifah NA, Zulfiqar MA, Maimunah A, Yahya A, Zainudin W

Med J Malaysia, 1993 Dec;48(4):421-6.

PMID: 8183166

Realtime ultrasonography with general purpose sector transducer was used to guide 87 percutaneous biopsies on 82 patients with lesions suspected to be mediastinal masses on plain chest radiographs. In seven patients who had dyspnea the biopsies were done in erect or semi-erect sitting positions. Definitive diagnosis was obtained from 66 lesions (80.5%) where 46 (70.0%) were mediastinal and the remaining 20 lesions (30.0%) arising from the lung. Of the 46 mediastinal lesions where specific diagnosis were made, 42 (91.0%) were anterior and four (0.9%) posterior mediastinal lesions. The majority of these anterior mediastinal masses were lymphomatous nodes followed by germ cell tumours whereas all four posterior mediastinal masses were neurogenic. Of the lung lesions, 19 were primary malignancies. The remaining lung lesion which was located posteriorly was cryptococcus infection. One patient developed massive hemothorax, but subsequently recovered. No significant complications were encountered in the remaining patients. Surgery was carried on 11 patients. There is correlation between definitive diagnosis from percutaneous biopsy and final diagnosis after surgery in 80% of patients. It is proposed that all percutaneous biopsies for thoracic masses which abut the chest wall and cause mediastinal widening on a plain chest radiograph be guided by ultrasound. It can be effectively accomplished with ease and safety even without the use of dedicated biopsy ultrasound probes or biopsy attachments, and on patients in erect or semi-erect positions.

Breaking Bad News: An essential skill for doctors

Abdul Hafidz MI, Zainudin LD

Med J Malaysia, 2016 02;71(1):26-7.

PMID: 27130740

Breaking bad news is a process of delivering news, which may negatively affect a patient's view of the future, however is an essential skill for doctors. There are a multitude of benefits if doctors can execute this task well, and will improve the disease journey for the patient. There are several published models including the SPIKES and ABCDE models to help guide the doctor to break bad news effectively. This important skill can be taught through various methods but the most effective may be actually observing a session by senior clinicians.

Fulltext Combination chemotherapy for small cell lung cancer

Sufarlan AW, Zainudin BM

Med J Malaysia, 1993 Jun;48(2):166-70.

PMID: 8394502

Small cell lung cancer (SCLC) disseminates early and has poor prognosis. However, SCLC is highly chemosensitive, thus chemotherapy has been established as the primary mode of treatment. Seventeen patients (15 males and 2 females) with median age of 60 years (range 49 to 74 years) were treated with combination cyclophosphamide 750 mg/m2, adriamycin 40 mg/m2, vincristine 1.4 mg/m2 on day 1 and etoposide (VP 16) 75 mg/m2 on days 1 to 3 (CAVE). This combination was given in 6 courses at 3 weekly intervals. The response to the chemotherapy and the quality of life of patients was assessed at the third cycle and after the completion of therapy (sixth cycle). The overall response rate was 76.4%; 52.9% achieved complete response and 23.5% had partial response. The survival rate at 6 months was 70.8% and 4 patients (23.5%) were still alive after 1 year of chemotherapy. The median survival after therapy was 36 weeks. There was a 30% overall improvement in the Karnofsky performance score at the completion of chemotherapy. This study illustrated that the CAVE regimen is effective and beneficial in the majority of our patients with small cell lung cancer.

Fulltext Therapeutic aerosol: principles and practices

Zainudin BM

Med J Malaysia, 1993 Sep;48(3):259-68.

PMID: 8183136

Delivering a drug direct to the site of disease has several advantages. In the case of aerosols, it only requires about one-twentieth of the oral dose of the drug to exert its effect, thus resulting in less or minimal systemic side-effects. The onset of action is fast and the efficacy is superior to the oral drug. Because of the anatomy of the airways which are protective against the inhalation of foreign substances, the aerosol particles must be inhaled in an optimal way in order to reach the sites of action which are the peripheral airways. The particle size must be small and the aerosol must be inhaled in a coordinated manner, especially when a pressurised metered dose inhaler is used. Because of the high pressure of the propellants used in the canister, the particles will travel at a rapid speed upon actuating, causing great impaction in the throat. Only a small percentage reaches the peripheral airways and this percentage is even smaller if the coordination between actuation and inhalation is poor. Spacers have been shown to be able to overcome this problem of incoordination and to reduce throat impaction. Alternatively, the breath-actuated dry powder inhaler can be effectively used. The nebuliser, which is another aerosol delivery system, needs proper setting of the flow rate of compressed air and an appropriate volume of solution in order to optimise the drug delivery.

Fulltext Hookworm infection and reinfection following treatment among Orang Asli children

Norhayati M, Oothuman P, Fatmah MS, Muzain Minudin Y, Zainuddin B

Med J Malaysia, 1995 Dec;50(4):314-9.

PMID: 8668049

In hookworm endemic areas where sanitation is often wanting, reinfection of treated children is a problem. This study was conducted to enumerate the prevalence and the reinfection rate of hookworm in 193 Orang Asli children following treatment with stat dose of 400mg of albendazole at 2 and 4 months post-treatment. All samples were examined using the Kato-Katz and Harada Mori techniques. The overall initial prevalence was 31.0%, with 27.0% in males and 34.0% in females although there was no statistical difference. Only 7.0% of the children had moderate intensity of infection. The overall infection rate at 2 and 4 months post-treatment was 11.0% and 8.0%. New cases were detected at 1.0% and 5.0% at 2 and 4 months post-treatment period. Reinfection rate 2 months post-treatment was 24.0%, and it was 30.0%, 4 months after treatment. All infection at 2 and 4 months post-treatment were light. Long-term strategies incorporating health education on personal hygiene, provision of toilets and safe water supply need to be adopted in these Orang Asli villages to control rapid reinfection.

An evaluation of the Beckman glucose analyser 2

Lim HH, Zaini-Rahman M

Med J Malaysia, 1979 Jun;33(4):317-20.

PMID: 522742

The future of medical education in Malaysia

Zaini A

Med J Malaysia, 2002 Dec;57 Suppl E:5-7.

PMID: 12733184

Fulltext Prevalence of diabetic retinopathy in the University Hospital diabetic population

Teoh GH, Yow CS, Ngan A, Zaini A

Med J Malaysia, 1983 Mar;38(1):77-9.

PMID: 6633344

One hundred and forty-five diabetic patients attending diabetic clinic over a four week period were fully examined in an adjacent eye clinic. The fundi were examined with a Halogen light direct ophthalmoscope and the Binocular Indirect Ophthalmoscope after mydriasis to assess the presence of retinopathy. 44.1 percent of patients examined had Opbthalmoscopicaliy detectable retinopathy while 11 percent were found to have 'serious diabetic eye disease'. The prevalence of diabetic retinopathy in Malaysia is comparable to those of Western countries and Japan.
Study site: Diabetic clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Fulltext Resection and reconstruction of retroperitoneal sarcoma of spinal roots

Imran Y, Zulmi W, Faisham WI, Zainal M

Med J Malaysia, 2004 Dec;59 Suppl F:75-7.

PMID: 15941171

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