MyMedR

Comparing various cut-offs of aspartate aminotransferase-to-platelet ratio index (APRI) in liver cirrhosis diagnosis among hepatitis C patients in Malaysia

Mohd Suan MA, Chan HK, Sem XH, Shilton S, Abu Hassan MR

Med J Malaysia, 2021 Nov;76(6):828-832.

PMID: 34806668

INTRODUCTION: A major challenge in providing hepatitis C virus (HCV) treatment at primary healthcare clinics is the lack of radiological facilities to guide the decision making of liver cirrhosis (LC). This study aimed to compare the performance of three commonly used cut-offs of the aspartate aminotransferase-to-platelet ratio index (APRI) in diagnosing LC among hepatitis C patients in Malaysia.

METHODS: This cross-sectional study was based on the data collected from the Hepatitis C Elimination through Access to Diagnostics (HEAD-Start) study in 25 primary healthcare clinics across three regions of Malaysia. The findings of biochemical tests were used to calculate the APRI for each study participant. Transient elastography was used as a standard reference for the diagnosis of cirrhosis. The area under the receiver operating curve (AUROC) was used to determine the discriminative ability of APRI in both HCV mono-infected and HCV/HIV co-infected patients. The diagnostic performance of APRI at three different cutoffs (>1.0, ≥1.5 and >2.0) were also evaluated.

RESULTS: This study included 867 HCV-RNA-positive patients, 158 (16.1%) were co-infected with HIV. For the HCV mono-infected patients, the sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) for the cut-off of >1.0 were 61.8%, 88.7%, 73.8% and 81.9%, and for the cut-off of ≥1.5, 45.6%, 97.0%, 88.7% and 77.6%, respectively. A much lower sensitivity (29.9%) was observed for the cut-off of >2.0. The diagnostic accuracy of APRI at the cut-off of ≥1.5 in the HCV/HIV co-infected patients was relatively suboptimal.

CONCLUSION: APRI, with a cut-off of ≥1.5, can more accurately predict LC among hepatitis C patients in Malaysia. However, additional physical examination and laboratory assessment are likely to be required to support the diagnosis, especially in those with HCV/HIV co-infection.

Fulltext The use of dental drill in removing entrapped finger by metal ring in emergency department

Shamsuddin SR, Hashim AA, Nazer B, Hashairi F, Shaik Farid AW, Abu Yazid MN

Med J Malaysia, 2012 Jun;67(3):349-50.

PMID: 23082436 MyJurnal

Ring removal is indicated in a number of clinical circumstances to manage or prevent tourniquet effect of the digit. A ring made from hardened metal may defy commonly known methods of removal. We reported a case of unusual difficulty in removing a ring of hardened metal composition using a dental drill. We believed the unusual circumstances of this case is likely to be repeated in some other clinical practice and this instrument is an appropriate option to consider in such cases.

Fulltext Isolation and identification of human herpesvirus 7 from an infant with exanthem subitum

Chua KB, Lam SK, AbuBakar S

Med J Malaysia, 1998 Sep;53(3):296-301.

PMID: 10968172

Exanthem subitum (ES) is a common childhood exanthematous disease. In a recent study of ES due to human herpesvirus 6 (HHV 6), we isolated human herpesvirus 7 (HHV 7) from the peripheral blood mononuclear cells (PBMC) of a seven month-old infant with typical symptoms of ES. The identity of the virus was confirmed by indirect immunofluorescence using HHV 7 specific monoclonal antibody and by amplification of the HHV 7 specific genomic sequences using the polymerase chain reaction (PCR). Paired serum samples from the infant showed serological conversion to the isolated virus. The clinical manifestations of ES in this infant appeared to be milder than the classical ES due to HHV 6.

Fulltext Guidelines for the management of childhood asthma--a consensus statement

Academy of Medicine of Malaysia

Med J Malaysia, 1997 Dec;52(4):416-28.

PMID: 10968121

Fulltext Acceptability of epidural analgesia for pain relief during labour among Kelantanese women

Sharma S, Mohamad NA, Monga D, Achana S

Med J Malaysia, 1996 Dec;51(4):453-6.

PMID: 10968033

Three hundred and five primigravid women were interviewed at term to assess the acceptability of epidural during labour, and reasons for the decisions. Data was collected on a prestructured proforma which consisted of background information, socio-economic status, knowledge about epidural analgesia, source of information and reasons for choice. Of the 305 patients only 17.3% were willing to receive epidural analgesia. This group consisted of 56.6% non-Malay women. Those employed in professional or skilled jobs (56.6%) also readily consented for epidural. Nearly half the women willing for epidural had received college (tertiary) education (43.3%) and more than a quarter (26.4%) were over 30 years of age. The majority of those who were unwilling had no prior knowledge about the procedure, and refused either out of fear, ignorance, resistance from husbands, on religious grounds or following poor feedback from friends. In order to advocate epidural analgesia, knowledge has to be targeted to the relatively less educated, unemployed women, mainly through the media or personally in the antenatal clinic by doctors and nurses. Services have to be improved as substandard analgesia may send out wrong messages and actually do more harm than good.

When polymyositis meets Graves' disease: A rare case report

Chai ST, Lim YS, Achok HN

Med J Malaysia, 2021 Nov;76(6):937-940.

PMID: 34806691

Polymyositis is rarely associated with Graves' disease. A 22- year-old woman was admitted for progressively worsening proximal muscle weakness of both upper and lower extremities. One month prior to admission, she was diagnosed with thyrotoxicosis and prescribed carbimazole 10mg twice daily. Neurological examination confirmed proximal myopathy and blood investigations revealed marked elevation of muscle enzymes, particularly creatine kinase. Electromyography demonstrated myopathic changes while right quadriceps muscle biopsy showed only traces of inflammatory myopathy. She was treated with pulsed intravenous methylprednisolone followed by tapering doses of oral prednisolone, which was eventually down-titrated to 5mg daily during subsequent clinic visits. The initial clinical improvement that she exhibited did not persist despite being rendered euthyroid. She was readmitted approximately one year later with the same complaint. A second course of intravenous methylprednisolone brought about clinical improvement as well as reduction of creatine kinase levels. A diagnosis of polymyositis was then made, for which she was managed with oral prednisolone 20mg daily in combination with gradual up-titration of azathioprine. She continued to show clinical and biochemical improvements during follow-ups. Polymyositis should be considered in the diagnostic workup of proximal myopathy in a patient with Graves' disease, especially in the setting of markedly raised muscle enzymes.

Fulltext Reliability, technical error of measurements and validity of length and weight measurements for children under two years old in Malaysia

Jamaiyah H, Geeta A, Safiza MN, Khor GL, Wong NF, Kee CC, et al.

Med J Malaysia, 2010 Jun;65 Suppl A:131-7.

PMID: 21488474

The National Health and Morbidity Survey III 2006 wanted to perform anthropometric measurements (length and weight) for children in their survey. However there is limited literature on the reliability, technical error of measurement (TEM) and validity of these two measurements. This study assessed the above properties of length (LT) and weight (WT) measurements in 130 children age below two years, from the Hospital Universiti Kebangsaan Malaysia (HUKM) paediatric outpatient clinics, during the period of December 2005 to January 2006. Two trained nurses measured WT using Tanita digital infant scale model 1583, Japan (0.01kg) and Seca beam scale, Germany (0.01 kg) and LT using Seca measuring mat, Germany (0.1cm) and Sensormedics stadiometer model 2130 (0.1cm). Findings showed high inter and intra-examiner reliability using 'change in the mean' and 'intraclass correlation' (ICC) for WT and LT. However, LT was found to be less reliable using the 'Bland and Altman plot'. This was also true using Relative TEMs, where the TEM value of LT was slightly more than the acceptable limit. The test instruments were highly valid for WT using 'change in the mean' and 'ICC' but was less valid for LT measurement. In spite of this we concluded that, WT and LT measurements in children below two years old using the test instruments were reliable and valid for a community survey such as NHMS III within the limits of their error. We recommend that LT measurements be given special attention to improve its reliability and validity.
Study site: Paediatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia

Fulltext A national database on children and adolescent with diabetes (e-DiCARE): results from April 2006 to June 2007

Fuziah MZ, Hong JY, Zanariah H, Harun F, Chan SP, Rokiah P, et al.

Med J Malaysia, 2008 Sep;63 Suppl C:37-40.

PMID: 19230245

In Malaysia, Diabetes in Children and Adolescents Registry (DiCARE) was launched nationwide in August 2006 to determine and monitor the number, the time trend of diabetes mellitus (DM) patients, their socio-demographic profiles, outcome of intervention and facilitate research using this registry. This is an on going real time register of diabetic patients < or = 20 years old via the e-DiCARE, an online registration system. To date were 240 patients notified from various states in Malaysia. The mean age was 12.51 years (1.08-19.75) and 46.4% were boys. The mean age at diagnosis was 8.31 +/- 4.13 years old with an estimated duration of diabetes of 4.32 +/- 3.55 years. A total of 166/240 (69.2%) have T1DM, 42/240 (17.5%) have T2DM and 18/240 (7.5%) have other types of DM. Basis of diagnosis was known in 162 patients with T1DM and 41 patients with T2DM. In T1DM patients, 6.0% of the girls and 19.1% boys were overweight or obese. As for T2DM, 64.3% had their BMI reported: 66.7% girls and 91.6% boys were overweight or obese. Most patients (80.4%) practiced home blood glucose monitoring. Patients were seen by dietitian (66.7%), diabetes educator (50.0%), and optometrist or ophthalmologist (45.0%). Only 10.8% attended diabetic camps. In the annual census of 117 patients, the mean HbAlc level was 10.0% + 2.2 (range 5.2 to 17.0%). The early results of DiCARE served as a starting point to improve the standard of care of DM among the young in the country.

Fulltext Psoriasis in hospital population

Adam BA

Med J Malaysia, 1980 Jun;34(4):370-4.

PMID: 7219266

Two hundred and three patients with psoriasis, who attended the skin clinic were studied to identify the pattern of sporiasis. The incidence was 4%. It was more common in Indians than in the other ethnic groups and this was found to be statistically significant. Males were affected twice as common, 12.5% gave a positive family history, the lower limbs and the scalp were the commonest site, and pruritus was frequent. The pattern appears similar to those in the west.
Study site: Skin clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Fulltext Cutaneous drug eruptions

Adam BA

Med J Malaysia, 1982 Jun;37(2):110-3.

PMID: 6215559

Patients attending a referral Skin Clinic were studied to identify the spectrum of drug eruptions and the offending drugs. There were 51 patients with an incidence of five per thousand and equal sex incidence. Though the pattern of eruption was broadly similar to other reports, unusual reactions were observed. In addition to the skin manifestation, fever and lymphadenopathy were present in most patients. Raised erythrocyte sedimentation rate and eosinopoenia were commonly observed. Clinical acumen and the list of drugs ingested are still the best clues to the diagnosis ofdrug eruption.
Study site: Skin clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

An open clinical trial comparing (paired comparisons) desoximetasone with betamethasone 17-valerate

Adam BA

Med J Malaysia, 1978 Jun;32(4):302-3.

PMID: 732627

Treatment of skin diseases: recent trends

Adam BA

Med J Malaysia, 1973 Mar;27(3):192-4.

PMID: 4268922

Lichen planus: variations in Indians

Adam BA

Med J Malaysia, 1973 Jun;27(4):284-8.

PMID: 4270787

Fulltext Predictors of mortality in patients with Acute Coronary Syndrome (ACS) undergoing Percutaneous Coronary Intervention (PCI): Insights from National Cardiovascular Disease Database (NCVD), Malaysia

Ponniah JP, Shamsul AS, Adam BM

Med J Malaysia, 2012 Dec;67(6):601-5.

PMID: 23770953 MyJurnal

The aim of this study is to determine risks factor of mortality among patient with post percutaneous coronary intervention. Estimation of post operative mortality risk factor is essential for planning prevention modalities. This is retrospective cohort study based on secondary data extracted from the National Cardiovascular Disease Database (NCVD-ACS and NCVD PCI). Both these registries were interlinked and was further matched to JPN (Jabatan Pendaftaran Negara/National registration Department) to assess mortality among the patients who underwent PCI and all death which occurred in between 2007, 2008 and 2009. There were 630 patients in this studied. Age, history of diabetes mellitus, peripheral vascular, renal failure and previous percutaneous coronary intervention were univariately associated with mortality. However based on logistics stepwise method, only age and history of renal failure had showed statistically significant and sizeable odds ratio in predicting the patient died of coronary death. Older age and renal failure are the predicting factors for mortality among patients with post percutaneous coronary intervention.

Fulltext The contribution of research in anaesthesia to clinical medicine

Adams AK

Med J Malaysia, 1988 Mar;43(1):9-13.

PMID: 3072469

Fulltext Routine coagulation tests in cases of missed abortion--is it really necessary?

Chandran R, Adeeb N

Med J Malaysia, 1992 Dec;47(4):287-9.

PMID: 1303481

Many gynaecological units have a policy of performing routine coagulation tests in cases of missed abortion. For many years now, it has been accepted practice in our unit to perform routinely a platelet count, bleeding time (BT), clotting time (CT) and plasma fibrinogen (P. fib) level prior to evacuation in cases of missed abortion. We are not sure how or why these 4 tests came to be chosen as a coagulation 'screen'. As they are not totally adequate in detecting disseminated intravascular coagulation (DIC), we wondered if these tests added to the management in any way.

Fulltext Detection of xanthine oxidase in human plasma

Newaz MA, Adeeb NNN

Med J Malaysia, 1998 Mar;53(1):70-5.

PMID: 10968141

Xanthine oxidase is a highly versatile enzyme which is widely distributed among various species. Though the presence of the enzyme in serum is not yet established, high antibody titre of this enzyme has been reported. Xanthine oxidase is thought to be the principal source of free radical generation via degradation of nucleotides to the end product, uric acid. The aim of this study was to detect xanthine oxidase activity in human plasma and report any significant relationships found between its activity and variables such as race, age and sex for the sample size studied. Forty six normal healthy individuals (14 males and 32 females) were studied. The enzyme activity was measured by a spectrophotometric method whereby the reduction of ferricytochrome c by free radicals was calculated and expressed as nmol O2 production/ml/min. Results obtained showed that there was a positive relationship between xanthine oxidase activity with age (r = 0.415, p < 0.05) and weight (r = 0.369, p < 0.05) in the normal individual. For the age group 30-39 yrs (n = 11), a higher enzyme activity was observed in males (2.71 +/- 1.44) as compared to females (2.34 +/- 1.23) but it was not significant (p = 0.53). For racial distribution, the Malays [M] have a higher enzyme activity (2.65 +/- 0.86, N = 32) than their Indian [I] (2.27 +/- 0.58; N = 7) and Chinese counterparts [C] (1.44 +/- 1.22; N = 7) but this was also not statistically significant (M vs I: p = 0.39; M vs C: p = 0.07; I vs C: p = 0.16). In conclusion this study showed that there is a measurable amount of xanthine oxidase activity in the human plasma.

Fulltext Outpatient treatment of spontaneous pneumothorax using an improved pocket sized Heimlich valve

Chan KY, Fikri-Abdullah M, Sajjad M, Adeeb SM

Med J Malaysia, 2003 Oct;58(4):597-9.

PMID: 15190637

We report two patients, who have used Pneumostat to replace the conventional underwater seal drainage system for recurrent pneumothorax. Both patients had required repeated chest tube insertion for recurrent pneumothorax and needed a longer hospital stay. Both patients were able to be discharged with the Pneumostat device and were reviewed in outpatient clinic. Both patients had optimal clinical improvement and chest X-ray showed no residual pneumothorax.

Implication of CDKAL1 single-nucleotide polymorphism rs 9465871 in obese and non-obese Egyptian children

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

Moving from long case to scenario-based clinical examination: Proposals for making it feasible

Puthiaparampil T, Rahman MM, Shazrina AR, Nariman S, Lukas S, Chai CS, et al.

Med J Malaysia, 2022 Nov;77(6):724-729.

PMID: 36448391

INTRODUCTION: Our faculty used one long case (LC) and three short cases for the clinical component of the final professional examinations. During the COVID-19 pandemic, the LC had to be replaced with scenario-based clinical examination (SBCE) due to the impracticability of using recently hospitalised patients. While keeping the short case component as usual, the LC had to be replaced with SBCE in 2020 for the first time at a short notice. To evaluate the positive and negative aspects of SBCE and LC to determine the feasibility of replacing LC with SBCE in future examinations.

MATERIALS AND METHODS: We compared the LC scores of three previous years with those of the SBCE and studied the feedback of the three stakeholders: students, examiners, and simulated patients (SPs), regarding their experience with SBCE and the suitability of SBCE as an alternative for LC in future examinations.

RESULTS: The SBCE scores were higher than those of the LC. Most of the examiners and students were not in favour of SBCE replacing LC, as such. The SPs were more positive about the proposition. The comments of the three stakeholders brought out the plus and minus points of LC and SBCE, which prompted our proposals to make SBCE more practical for future examinations.

CONCLUSION: Having analysed the feedback of the stakeholders, and the positive and negative aspects of LC and SBCE, it was evident that SBCE needed improvements. We have proposed eight modifications to SBCE to make it a viable alternative for LC.

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