MyMedR

Dengue shock syndrome with retroperitoneal haematoma requiring repeated artery angioembolization

Teh YH, Tan YP, Zain MM

Med J Malaysia, 2017 08;72(4):254-256.

Eyelid reconstruction is complex and challenging since it is not only for structural and functional restoration, but also for an acceptable aesthetic result. In full thickness eyelid injuries, it will involve both anterior and posterior lamella. Therefore, when reconstructing the defect, it requires at least two layers; one will be a flap with blood supply, and the other can be a free graft. In this case, a rotational advancement cheek flap and composite graft were used to reconstruct the lower eyelid.

Fulltext Treatment of bleeding gastroesophageal varices: a report of forty-four cases

Tay SK, Leong YP, Meah FA, Abdullah T, Zain AR

Med J Malaysia, 1992 Dec;47(4):267-72.

PMID: 1303478

Bleeding gastroesophageal varices is associated with a high morbidity and mortality. Forty-four cases of bleeding gastroesophageal varices were treated at the Department of Surgery, Universiti Kebangsaan Malaysia, General Hospital, Kuala Lumpur over four and a half years. Thirty-two of them had liver cirrhosis. Hepatitis B infection was noted in 13 and alcoholic abuse was present in 14 patients. Five patients had associated hepatoma. Thirty-four percent had gastric fundal varices and a third of these bled from them. A total of 179 endoscopic injection sclerotherapy sessions were performed averaging 4 per person. Rebleeding rate was 4% and mortality was high (50%) in these cases. It was concluded that injection sclerotherapy is a safe and effective means of controlling bleeding oesophageal varices. Operative surgery was employed in those who rebled after injection and would be considered in those in Child's A.

Fulltext Profile of in-patient suicides in two hospitals in Malaysia

Zain AM

Med J Malaysia, 1991 Jun;46(2):171-6.

PMID: 1839422

A study of completed in-patient suicides at the University Hospital Kuala Lumpur (UHKL) and Hospital Bahagia Ulu Kinta (HBUK) between 1st January 1967 to 31st December 1987 were conducted. Records of completed in-patient suicides during the period were exhaustively studied. Only 18 cases were from UHKL and 23 cases were from HBUK. It was found that the suicide patients were mainly young Chinese males from the lower socio economic group. The main reasons for suicide were interpersonal conflicts and physical illness. Alcohol was not an important factor unlike patients in the West.. Suicidal intent was also important. Many of the suicides were committed during the early hours of the morning and they usually occurred at inaccessible places. The method was strongly influenced by availability. To the best knowledge of the author, this is the first study of in-patient suicides in Malaysia.

Fulltext True hallucination as conversion symptom--a case report

Zain AM

Med J Malaysia, 1990 Mar;45(1):74-7.

PMID: 2152073

The concept of conversion hallucination is a relatively new one, however there have been several articles written on this phenomena, some attesting to it being a special form of hallucination while others dismissing it altogether. But currently this concept is slowly being accepted among psychiatrists and as such it is important for us to understand some of the concepts. In this case report, the patient presented with clear conversion hallucinations. The case is followed by a discussion on true and pseudo-hallucinations, previous case reports and finally a discussion of conversion hallucinations, viz. the clinical features and the conversion hypothesis.

Fulltext Breast cancer and lifestyle risks among Chinese women in the Klang Valley in 2001

Hejar AR, Chong FB, Rosnan H, Zailina H

Med J Malaysia, 2004 Jun;59(2):226-32.

PMID: 15559174 MyJurnal

Breast cancer is one of the commonest cancers among women in Malaysia. The relation between lifestyle practices and the risk of breast cancer in Chinese women aged 21-55 years were assessed using data collected from June to October 2001, via a face-to face interview in a case control study in the Breast Clinics of Kuala Lumpur Hospital and University Malaya Medical Centre. A total of 89 cases with breast cancer were compared with 85 controls without the disease. Our study showed that breastfeeding had an odds ratio of 4.43 after adjustment for confounders. The results add to the evidence of a protective association between breast feeding practices and breast cancer particularly among Chinese women receiving treatment at two government hospitals in the Klang Valley.

Prothrombotic markers in Thalassemia major patients: A paradigm shift

Sultan S, Irfan SM, Zaidi SM

Med J Malaysia, 2018 08;73(4):185-189.

PMID: 30121679

BACKGROUND: It is being increasingly recognised that thalassemia major patients, like intermedia, have increased propensity for thromboembolism. Deficiency of natural anticoagulants is more recently defined finding contributing to the hypercoagulable state. The aim this study is to determine natural anticoagulants levels and their correlation with maternal characteristics, haematological and biochemical markers.

METHODS: This is a prospective case-control study. We registered 80 patients and 60 healthy controls from Jan 2009 to Dec 2013. Complete blood counts, prothrombin time, activated partial thromboplastin time, protein C, protein S, antithrombin, serum ferritin, liver enzymes; HbsAg and Anti- HCV were evaluated.

RESULT: There were 42 males and 38 females with mean age of 12.30±5.50 years. The mean protein C, protein S and antithrombin in patients and control were 58.25±22.5 versus 110.67±22.60, 67.90±19.58 versus 98.70±21.54 and 89.73±18.09 versus 104.0±10.98 (p<0.001) respectively. Protein C was predominantly deficient in 65% followed by protein S and antithrombin in 35% and 20% respectively. Protein C deficiency divulged positive correlation with protein S deficiency (p = 0.035) and antithrombin deficiency with hemoglobin of ≤8gm% (p<0.0025). No significant correlation of prothrombotic markers was established with maternal characteristics, hepatic dysfunction, hepatitis and serum ferritin.

CONCLUSION: Substantial decrement in prothrombotic markers, primarily protein C, may be implicated in elevated thrombosis; however follow-up data is required to establish definitive thromboembolic events.

A case of Multisystem Inflammatory Syndrome in adults in Malaysia

Seow CK, Gan WF, Zaidan NZ

Med J Malaysia, 2022 01;77(1):121-124.

PMID: 35087012

Multisystem Inflammatory Syndrome in Adults (MIS-A) is a rare but potentially life-threatening complication following SARS-CoV-2 infection. We present a Malaysian case of MISA in a 45 year old gentleman who developed cardiogenic shock following a mild SARS-CoV-2 infection.

Fulltext Temporal bone squamous cell carcinoma - Penang experience

Ng SY, Pua KC, Zahirrudin Z

Med J Malaysia, 2015 Dec;70(6):367-8.

PMID: 26988214 MyJurnal

Temporal bone squamous cell carcinoma (TBSCC) is rare and poses difficulties in diagnosing, staging and management. We describe a case series with six patients who were diagnosed TBSCC, from January 2009 to June 2014, with median age of 62 years old. All patients presented with blood-stain discharge and external auditory canal mass, showing that these findings should highly alert the diagnosis of TBSCC. Three patients staged T3 and another three with T4 disease. High-resolution CT (HRCT) temporal findings were noted to be different from intraoperative findings and therefore we conclude that MRI should be done to look for middle ear involvement or other soft tissue invasion for more accurate staging. Lateral temporal bone resection (LTBR) and parotidectomy was done for four patients with or without neck dissection. Patients with positive margin, perineural invasion or parotid and glenoid involvement carry poorer prognosis and postoperative radiotherapy may improve the survival rate. One patient had successful tumor resection via piecemeal removal approach in contrast with the recommended en bloc resection shows that with negative margin achieved, piecemeal removal approach can be a good option for patients with T2-3 disease. In general, T4 tumor has dismal outcome regardless of surgery or radiotherapy given.

Fulltext Combined laparoscopic cholecystectomy and drainage of pancreatic pseudocyst: a case report and review of current management

Che Jusoh MA, Hassan J, Mohd Nor R, Kong CF, Zahirah Awang NF

Med J Malaysia, 2013 Jun;68(3):273-4.

PMID: 23749024 MyJurnal

Pancreatic pseudocyst is a well recognized complication of acute or chronic pancreatitis. Active treatment (surgical or endoscopic) has been recommended if the pseudocyst persists for more than 6 weeks after the diagnosis. Open trans-abdominal drainage was initially the mainstay treatment for it. However, over the past decade, laparoscopic techniques have been developed to provide patient with minimal access alternative. We report a case of a large symptomatic pseudocyst which developed following attack of severe gallstone pancreatitis. Laparoscopic cholecystectomy and cysto-gastrostomy were done at the same sitting. The operative technique is briefly explained.

Fulltext Symptomatic intra-articular ganglion cyst of the knee

Aminudin CA, Samsudin OC, Hyzan MY, Hamzaini AH, Zahiah M

Med J Malaysia, 2004 Dec;59 Suppl F:57-9.

PMID: 15941165

We are reporting a case of a patient with a symptomatic intra-articular ganglion of the knee arising from infrapatellar fat pad. Plain radiograph and Magnetic Resonance (MR) images were correlated with arthroscopic examination and histological findings. The cyst was removed and post operatively patient regained full extension.

Fulltext Diagnosis and management of blunt pancreatic trauma: a case report with review of the literature

Khan TF, Zahari A

Med J Malaysia, 1993 Jun;48(2):244-7.

PMID: 8350806

Details of a young logger who sustained a clean prevertebral transection of the pancreas to the left of the superior mesenteric vessels and a crush injury in segments 2 and 3 of the liver are presented. CT scan was not done but ultrasound scan revealed free intraperitoneal fluid and no comment was made about the pancreas. The pancreatic injury was discovered at laparotomy carried out 24 hours after admission and treated by resection.

Development of perceptions and attitudes towards Intimate Partner Violence questionnaire for premarital young adults

Wan Soliha WMH, Tengku Alina TI, Anis Kausar G, Zaharah S

Med J Malaysia, 2021 09;76(5):658-664.

PMID: 34508371

OBJECTIVE: The age of young adults is a critical period as they start to explore intimate relationship and prepare for marriage. Although instruments on intimate partner violence (IPV) are available, few include potential predictors of this violent behaviors such as perceptions and attitudes. Therefore, this study aimed to develop a questionnaire to assess perceptions and attitudes toward IPV among premarital young adults.

METHODS: The questionnaire was developed in two stages: item development and scale development. Two forms of validity evidence were applied, which were content validity index (CVI) and face validity index (FVI), to estimate the content validity, response process and internal structure of the tool. This cross-sectional study was conducted among premarital young adults in Kota Bharu, Kelantan. The questionnaire assessed perceptions and attitudes toward IPV on six related components, which were its forms, causes, impacts, supports, acceptance and willingness to disclose.

RESULTS: CVI values for both perceptions and attitudes domains were more than 0.83. Five of the components have few items with low agreement by experts, hence those items were dropped. FVI values for the six domains among premarital young adults were at least 0.83, thus all these items were retained. The final result of development of this questionnaire were 64 items for perceptions and 23 items for attitudes, with five-Likert scale response option.

CONCLUSION: The newly developed tool, named as MYPAIPVQ, is valid based on content validity and face validity to assess perceptions and attitudes toward intimate partner violence among premarital young adults. Before it can be used, further validation studies should be conducted to determine its psychometric properties.

Fulltext Intention and actual exclusive breastfeeding practices among women admitted for elective cesarean delivery in Kelantan, Malaysia: A prospective cohort study

Nazirah J, Noraini M, Norkhafizah S, Tengku Alina TI, Zaharah S

Med J Malaysia, 2020 05;75(3):274-280.

PMID: 32467544

INTRODUCTION: The intention of a woman to breastfeed is one of the predictors of breastfeeding initiation and duration.

OBJECTIVE: The aim of this study is to determine exclusive breastfeeding (EBF) intention among women admitted for elective cesarean delivery in Kelantan and their postnatal EBF practices.

METHODS: A total of 171 women, mostly Malays, admitted for elective cesarean delivery at two tertiary hospitals in Kelantan participated in this prospective cohort study. The Malay version of Infant Feeding Intentions (IFI) scale was administered one day before the surgery to determine the EBF intention, and follow-up phone calls were made at one month, three months, and six months after delivery to determine the actual EBF practices.

RESULTS: Before delivery, 86.5%, 82.5% and 77.2% of the women somewhat agreed or very much agreed to practice EBF for 1, 3 and 6 months respectively and the actual EBF practices after delivery were 80.1%, 59.6%, and 42.1%. Women who had the intention to practice EBF for 6 months were about 2 times more likely to practice EBF for 6 months than those who did not have the intention to EBF (OR 2.19, 95% CI: 1.01-4.76). No significant association was found between EBF intention and the actual EBF practices at 1 month and 3 months postnatal.

CONCLUSIONS: The number of women who practiced EBF after cesarean delivery was lower than those who had the intention prior to delivery. The number further declined as the child grew older. Prenatal EBF intention was associated with actual postnatal EBF practices at 6 months.

Fulltext Ultrasound (US) and computed tomographic (CT) appearances of large (giant) hepatic cavernous hemangiomas

Samad SA, Maimunah A, Zulfiqar A, Zaharah M

Med J Malaysia, 1995 Mar;50(1):82-6.

PMID: 7752982

The sonographic and CT appearances of 9 large cavernous hemangiomas of the liver were studied. On sonography, 6 masses (67%) exhibit heterogenous echo pattern; where in 2 patients the echotexture was a mixture of hypoechoic and isoechoic areas and in 4 patients there are varying amounts of bright hyperreflective areas similar to the texture typical of small hemangiomas. The masses were predominantly hypoechoic in the remaining 3 patients (33%). Incremental bolus or bolus-infusion dynamic CT showed peripheral contrast enhancement of varying intensities and thickness in all patients. The lesions were incorrectly diagnosed as hepatomas in 4 patients, suspected as hemangiomas with a differential diagnosis of hepatomas in 4 patients and an early liver abscess in 1 patient. It is concluded that large cavernous hemangiomas of the liver do not exhibit the typical homogenous hyperreflective echotexture as exhibited by small lesions and they mimic primary and secondary hepatic neoplasms. However, the diagnosis of hemangioma should be entertained when such a mass contains bright hyperechoic areas within its heterogenous echo pattern and exhibit peripheral enhancement on contrast enhanced CT. In addition to correlation with appropriate clinical information, confirmation of diagnosis include delayed scanning during a routine incremental bolus dynamic CT, single-slice dynamic contrast enhanced CT, angiography or isotope scintigraphy and magnetic resonance imaging depending on the availability of facility.

Induction of labour survey: A need for standardisation and/or change in practice

Zahar AZ

Med J Malaysia, 2022 Jan;77(1):82-84.

PMID: 35086998

Induction of labour is one of the most common antepartum intervention. There are numerous methods available but the most commonly used in Malaysian public hospital is the intravaginal dinoprostone. This survey highlighted the various practices of using dinoprostone for different group of pregnant women which are unfortunately, not supported by robust clinical evidence. As such, it calls for futher studies to allow future practice standardization. Alternatively, the use of misoprostol for induction of labour, which has better data profile, should also be considered.

Fulltext Challenges in clinical research in Malaysia

Zabidi-Hussin ZA

Med J Malaysia, 2007 Oct;62(4):275-7.

PMID: 18551927 MyJurnal

A colonic amoebic abscess mimicking colonic carcinoma

Tan LP, Foong KK, Yvonne Ai LL

Med J Malaysia, 2018 10;73(5):334-335.

PMID: 30350818 MyJurnal

Amebiasis is one of the major causes of diarrhea in the developing countries and it can present with a wide range of gastrointestinal symptoms depending on the phase of infection. We described a case of 50 year-old male patient who presented with abdominal pain, diarrhea and vomiting. After right hemicolectomy for appendicular abscess with tumour over the ileum, histopathological examinations revealed numerous trophozoites of Entamoeba histolytica in a background of inflammations (Figure 1). Following resection of the ameboma, he received intravenous metronidazole treatment for total of two weeks duration.

Fulltext The effectiveness of permethrin-impregnated bed nets for malaria control in Kg. Ganoh, an Orang Asli area of Rompin District, Pahang

Amal NM, Yussof S

Med J Malaysia, 1996 Dec;51(4):491-3.

PMID: 10968043

Fulltext Experience with malignant tumours of the maxillary sinus in the Department of Otolaryngology Universiti Kebangsaan Malaysia, Kuala Lumpur

Lokman S, Said H, Hakim J, Yusop S

Med J Malaysia, 1989 Mar;44(1):64-8.

PMID: 2626115

Thirty one cases of malignant tumours of the maxillary sinus presenting to the Department of Otolaryngology, Universiti Kebangsaan Malaysia over a four year period from 1982 to 1986 are reviewed. 18 cases (58.1%) were squamous cell carcinoma while seven cases (22.5%) were Non-Hodgkin's lymphoma. There were four cases (12.0%) of adenoid cystic carcinoma while in two cases (6.5%) the tumours were undifferentiated. Presentation was generally late. Nasal obstruction, facial swelling and epistaxis were the main presenting symptoms. Nasal involvement was found in 61.3% of cases, while 51.6% had involvement of the palate as well. Metastasis to the cervical lymph node were uncommon (6.5%). Surgery and radiotherapy with or without chemotherapy were the main modes of treatment in the management of malignant tumours of the maxillary sinus.

Fulltext Perioperative blood pressures: continued care and caution

Yusoff K

Med J Malaysia, 2007 Jun;62(2):95-6.

PMID: 18705437 MyJurnal

Getting through major surgeries safely and timely with success and minimal complications is one of the great achievements of modern medicine. As the surgical techniques and the organs and systems involved become more varied, there are a number of important issues which determine the success of surgery. But one overriding theme is cardiovascular stability during and immediately after surgery.

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