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Fulltext Bleeding jejunal GIST: An uncommon cause of gastrointestinal bleeding

Mohanaraj T, Hanif H, Zainal AA

Med J Malaysia, 2015 Feb;70(1):31-2.
PMID: 26032526 MyJurnal

Gastrointestinal stromal tumours (GIST) are rare gastrointestinal tumours and are one of the causes of obscure gastrointestinal bleeding. We report a case of massive gastrointestinal bleeding secondary to bleeding jejunal GIST in a 43 years old gentleman. Endoscopic intervention failed to identify the source of bleeding and CT Angiography (CTA) showed a jejunal mass and patient underwent laparotomy and resection of the bleeding jejunal GIST. This article highlights the rare cause of the massive GI bleeding and also emphasise the role of CTA in obscure GI bleeding.
Fulltext Descriptive review of safety, reactogenicity and immunogenicity of dengue vaccine clinical trials, 2003 - 2013

Jelitha R, Nirmalatiban P, Nyanamalar S, Cabriz MG

Med J Malaysia, 2015 Apr;70(2):67-75.
PMID: 26162380

Dengue vaccine development has been one of the strategies to reduce dengue incidence in the world alongside with other horizontal interventions such as vector control and the transgenic mosquito programmes. The objective of this paper is to evaluate the safety, reactogenicity and immunogenicity of dengue vaccine clinical trials for the last ten years systematically through a descriptive review. This paper discusses safety issues like adverse events, systemic adverse reactions, injection site reactions, viraemia, morbidity and mortality as well as immunogenicity which measures effectiveness through mean geometric titre and seropositive rates. Adverse events were seen to range from 0% to 28.3%. Immunogenicity was noted to increase post 1st and 2nd dose and decrease post 3rd dose. The seropositivity at baseline ranged between 53.1% and 97.8% at post 3rd dose, and it was 88.5% for at least four serotypes. The dengue vaccine studies that were reviewed were shown to be relatively safe with low reactogenicity, however the immunogenicity was unequal and waning. The immunogenicity waned post 3rd dose showing a decrease in all serotypes of varying degrees although the seropositivity, on average, at post 3rd dose was 97.8%. It can be concluded that dengue vaccine development would require further studies on its unequal and waning immunogenicity, which could result in a more severe form of dengue following wild infection, during re-immunisation, especially if there is variation in the circulating virus.
Fulltext Internal jugular vein height and inferior vena cava diameter measurement using ultrasound to determine central venous pressure: a correlation study

Nik Muhamad NA, Safferi RS, Robertson CE

Med J Malaysia, 2015 Apr;70(2):63-6.
PMID: 26162379 MyJurnal

OBJECTIVE: To determine the correlation between central venous pressure (CVP) measured by conventional central venous access and ultrasonographic measurement of internal jugular vein (IJV) height and inferior vena cava (IVC) diameter.
METHODS: A prospective, cross-sectional, convenience sampling observational study.
RESULTS: 25 patients from the Emergency Department (ED) Universiti Kebangsaan Malaysia Medical Centre (UKMMC) were studied between 1st March and 30th April 2013. The median age was 63 years (95% CI 54-67). There was a significant correlation between IJV height and CVP using central venous access (r=0.64 p<0.001). Correlation between IVC diameter in end expiration and CVP was 0.74 (p<0.001). An IJV height measurement >8cm predicted a CVP >8cm H2O (sensitivity 71.4%, specificity of 83.3%).
CONCLUSION: Measurement of IJV height and IVC diameter by ultrasonography correlates well with invasive CVP and is useful for the assessment of volume status in critically ill patients in the ED.
Study site: Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur
Fulltext Clinical presentation and microorganisms sensitivity profile for diabetic foot ulcers: a pilot study

Nur Hilda Hanina AW, Intan NS, Syafinaz AN, Zalinah A, Lailatul Akmar MN, Devnani AS

Med J Malaysia, 2015 Jun;70(3):182-7.
PMID: 26248782 MyJurnal

INTRODUCTION: Patients suffering from diabetes mellitus (DM) frequently present with infected diabetic foot ulcers (DFU). This study was done to record the anatomical site and the grade of ulcers according to Wagner's classification and to culture the microorganisms from the ulcers and determine their antibiotic sensitivity.
MATERIALS AND METHODS: Prospective study was conducted on 77 diabetic patients who were admitted with DFU from June until December 2011. Patients with end stage renal failure, those who had previous vascular surgery on the involved limb, or hyperbaric oxygen or maggot therapy for the ulcers, or had unrelated skin diseases around the involved foot were excluded from the study. Specimens for culture were obtained by a sterile swab stick or tissue sample was taken from the wound with sterile surgical instruments.
RESULTS: Wagner's grade III and IV ulcers were most common. Majority of the ulcers involved toes (48%). Gram negative microorganisms were predominantly isolated (71.1%). Gram positive microorganisms were less frequently cultured (27.7%). Fungus was cultured from one sample (1.2%). Gram negative microorganisms were sensitive to aminoglycosides, cephalosporins or β-lactamase inhibitors. More than 40% were resistant to ampicillin. Gram positive microorganisms were sensitive to cloxacillin. MRSA were sensitive to vancomycin.
CONCLUSION: Empirical use of antibiotics should be curtailed to prevent development of drug resistant strains of microorganisms and MRSA. We suggest use of antiseptic solutions to clean the ulcers until antibiotic sensitivity report is available. Results of our altered treatment regimen we plan to publish in a later study.
Fulltext Clinical profile, morbidity and outcome of adult patients with psoriasis at a district hospital in Northern Malaysia

Loo CH, Chan YC, Lee KQ, Tharmalingam P, Tan WC

Med J Malaysia, 2015 Jun;70(3):177-81.
PMID: 26248781 MyJurnal

INTRODUCTION: Psoriasis is a common, chronic, relapsing, immune-mediated inflammatory disease. Our objective is to review the clinical profile, co-morbidities, and outcome of patients with psoriasis.
METHODS: This is a cross-sectional study of outpatient psoriasis patients attending the dermatology clinic, Hospital Sultan Abdul Halim (HSAH) between January 2012 and June 2014. Data collection was based on Malaysian Psoriasis Registry.
RESULTS: Among 296 patients with psoriasis, Malays were the most common 175 (59.1%), followed by Indians 82 (27.7%), Chinese 37 (12.5%) and others 2 (0.6%). Male to female ratio was 1.2:1. More than half (54.7%) of the patients had early onset disease (age 40 or less). Only 26 patients (8.8%) have positive family history. The most common clinical presentation was chronic plaque psoriasis (89.9%), followed by erythrodermic psoriasis (4.7%), guttate psoriasis (3.0%) and pustular psoriasis (1.7%). Twenty eight percent had nail involvement while arthropathy was seen only in 14.7%. Common triggers were sunlight (46.0%), stress (31.1%), trauma (5.4%), food (4.0%), pregnancy (4.0%), and upper respiratory tract infections (2.7%). Co-morbidities observed include ischaemic heart disease (7.1%), hypertension (26.7%), dyslipidemia (17.6%), and diabetes mellitus (22.0%). All patients were on topical medications. About 6.8% of the patients were treated with phototherapy. One third of patients (35.5%) were given systemic therapy. Out of these, 84 patients (80.0%) were on methotrexate while only 16 (15.2%) on acitretin. None was on cyclosporine or biologic. In term of disease severity, 41.7% of patients had BSA >10% and 31.4% patients had DLQI > 10.
CONCLUSION: Our patients show a similar clinical profile and outcome as our Malaysian psoriasis population. However they tend to have a more severe disease. There is a need for a more effective targeted therapy for a better outcome.
Study site: Dermatology clinic, Hospital Sultan Abdul Halim (HSAH), Sungai Petani, Kedah, Malaysia
Fulltext A tale of two construct validation analysis: Rasch model and exploratory factor analysis approach for Three-Factor Eating Questionnaire (TFEQ-R21) among Malaysian male workers

Rosnah I, Mohd Zali MN, Noor Hassim I, Azmi MT

Med J Malaysia, 2015 Jun;70(3):169-76.
PMID: 26248780 MyJurnal

INTRODUCTION: This study aims for construct validation using two approaches, i.e., exploratory factor analysis and Rasch Model.
METHODS: A cross sectional of 313 male workers from multiple worksites had completed self-administered Malay translated version of Three-Factor Eating Questionnaire- R21. Data quality was assessed by misfit person criteria, dimensionality, summary statistic, item measure and rating (partial credit) scale followed by exploratory factor analysis and internal consistency reliability assessment.
RESULTS: The dual approaches of construct validation analysis were complement to each other. Rasch analysis supported the theoretical constructs of three eating behaviour dimensions among respondents. In contrary to exploratory factor analysis, it did show presence of a newfound factor (∝=0.04) came up from the separation of the cognitive restrain and uncontrolled eating however, the correlation between the two respective sub-factors were fair (r=0.39) and weak (r= -0.08). Both analyses had detected three problematic items but those items were psychometrically fit for used for current study setting. The data had adequate psychometric properties. Cronbach's alpha for cognitive restraint, uncontrolled eating and emotional eating were 0.66, 0.79 and 0.87 respectively. Rating scale quality was conformed to standard criteria.
CONCLUSION: Malay version TFEQ-R21 with promising psychometric properties and valid measures for eating behaviour dimensions among male workers aged between 20 to 60 years old is now available. Further development should focus on the items in relation to Malaysian cultural adaptation before its use for daily practice in future setting.
Fulltext Bacterial pathogens and antibiotic resistance patterns in children with urinary tract infection in a Malaysian tertiary hospital

Noor Shafina MN, Nor Azizah A, Mohammad AR, Faisal MF, Mohamad Ikhsan S, Hafizah Z, et al.

Med J Malaysia, 2015 Jun;70(3):153-7.
PMID: 26248777 MyJurnal

INTRODUCTION: Urinary tract infection (UTI) is a common bacterial infection affecting children and therefore, prompt recognition and accurate antimicrobial management are vital to prevent kidney damage. This study aims to determine the bacterial pathogens and their patterns of antimicrobial resistance in children presenting with UTI.
METHODS: A retrospective study of 721 cases, involving children between the ages of 1-day old to 13 years old with culture-proven UTI in Selayang Hospital, Malaysia between January 2007 and December 2011. The bacterial pathogens and antibiotic resistance patterns in the total population, prophylaxis and no prophylaxis groups were studied.
RESULTS: The 3 most common organisms isolated in the total population were E.Coli (41.6%), Klebsiella spp. (21.2%) and Enterococcus spp. (11.0%). With regards to the antibiotic resistance, E.Coli resistance rates to ampicillin, cefuroxime and gentamicin were 67.7%, 15.3% and 7.3% respectively. Ampicillin-resistance was also highest in Klebsiella spp. (84.3%), Enterococcus spp. (15.5%) and Proteus spp. (55.5%).
CONCLUSION: E.coli remains to be the leading bacterial pathogen causing UTI in children, with ampicillin-resistance occurring in more than half of these cases. Therefore, accurate choice of antibiotics is important to ensure optimal outcome. In our study, cefuroxime and gentamicin have lower antibiotic resistance rates and can be used in the treatment of UTI in children.
Factors influencing late stage of breast cancer at presentation in a district Hospital - Segamat Hospital, Johor

Cheng ML, Ling DY, Nanu P KP, Nording H, Lim CH

Med J Malaysia, 2015 Jun;70(3):148-52.
PMID: 26248776 MyJurnal

INTRODUCTION: In Malaysia, late stage presentation of breast cancer (stage III or IV) has been a healthcare problem that varies geographically throughout the country. This study aims to understand the factors influencing late stage of breast cancer at presentation among Malaysian women in Segamat Hospital, Johor, which is a district hospital.
METHODS: A retrospective descriptive study was conducted on secondary data of all newly diagnosed breast cancer women from 1st August 2011 to 28th February 2014. Secondary data includes age, ethnicity, marital status, family history, education level, occupation, presenting symptom, duration of symptom, tumour size, tumour pathology, tumour grading, oestrogen, progesterone and HER-2 receptor status were collected and analysed using SPSS version 20.0.0.
RESULT: In total, data from 52 women was analysed and two women were excluded for incompleteness as these women defaulted. Late stage at presentation was 59.6% of all new cases (17.3% stage III and 42.3% stage IV). The commonest age group of all women diagnosed with breast cancer was in the 5th decade. Majority of them were Malay, married and housewives with no family history of breast cancer. The statistically significant factors associated with late stage at presentation include Malay ethnicity (p=0.019), presenting symptoms other than breast lump (p=0.047), and duration of breast lump more than 3 months (p=0.009).
DISCUSSION/CONCLUSION: The study demonstrated presentation at late stage of breast cancer is a major health concern among Malaysian women in district hospital. This may be attributed to different sociocultural beliefs, strong belief in complementary and alternative medicine, lack of awareness, and difficult accessibility to healthcare services.
Fulltext Knowledge, attitude and practice among healthcare staffs in the Emergency Department, Hospital Universiti Sains Malaysia towards Rape Victims In One Stop Crisis Centre (OSCC)

Chew KS, Noredelina MN, Ida ZZ

Med J Malaysia, 2015 Jun;70(3):162-8.
PMID: 26248779 MyJurnal

INTRODUCTION: Aimed at providing integrated multi-level crisis intervention to women experiencing violence such as rape, One Stop Crisis Centre (OSCC) in Malaysia is often located in the emergency department. Hence, it is imperative that emergency department healthcare providers possess adequate knowledge and acceptable attitudes and practices to ensure the smooth running of an efficient OSCC work process.

METHOD: To study the knowledge, attitude and practice of rape management in OSCC among four groups of healthcare providers in the emergency department [i.e., the emergency medicine doctors (EDs), the staff nurses (SNs), the medical assistants (MAs) and the hospital attendants (HAs)], a selfadministered questionnaire in the form of Likert scale was conducted from January to October 2013. Correct or favourable responses were scored appropriately.

RESULTS: Out of the 159 participants invited, 110 responded (69.2% response rate). As all data sets in the Knowledge, Attitude and Practice sections are non-parametric, Kruskal- Wallis test was performed. Homogeneity of variance was verified using non-parametric Levene test. In all three sections, there are statistically significant differences in scores obtained among the four groups of healthcare providers with H(3) = 16.0, p<0.001 for Knowledge, H(3) = 27.1, p<0.001 for Attitude and H(3) = 15.8, p<0.001 for Practice sections. Generally, the SNs obtained the highest mean rank score in the knowledge and practice sections but the EDs obtained the highest mean rank score in the attitude section. Some of the responses implied that our healthcare providers have the victim-blaming tendency that can negatively impact the victims.

CONCLUSION: Healthcare providers must not only have adequate knowledge but also the non-judgemental attitude towards victims in OSCC.
Role of high resolution ultrasound in ulnar nerve neuropathy

Radhika S, Lee YL, Low SF, Fazalina MF, Sharifah Majedah IA, Suraya A, et al.

Med J Malaysia, 2015 Jun;70(3):158-61.
PMID: 26248778 MyJurnal

AIM: This study was conducted to measure the cross sectional area (CSA) of the ulnar nerve (UN) in the cubital tunnel and to evaluate the role of high-resolution ultrasonography in the diagnosis of ulnar nerve neuropathy (UNN).
MATERIALS AND METHODS: This was a cross sectional study with 64 arms from 32 patients (34 neuropathic, 30 nonneuropathic). Diagnosis was confirmed by nerve conduction study and electromyography. The ulnar nerves were evaluated with 15MHz small footprint linear array transducer. The ulnar nerve CSA was measured at three levels with arm extended: at medial epicondyle (ME), 5cm proximal and 5cm distal to ME. Results from the neuropathic and nonneuropathic arms were compared. Independent T-tests and Pearson correlation tests were used. P value of less than 0.05 was considered significant.
RESULTS: Mean CSA values for the UN at levels 5cm proximal to ME, ME and 5cm distal to ME were 0.055, 0.109, 0.045 cm(2) respectively in the neuropathic group and 0.049, 0.075, 0.042 cm2 respectively in the non-neuropathic group. The CSA of the UN at the ME level was significantly larger in the neuropathic group, with p value of 0.005. However, there was no statistical difference between the groups at 5cm proximal and distal to the ME, with p values of 0.10 and 0.35 respectively.
CONCLUSION: There is significant difference in CSA values of the UN at ME between the neuropathic and non-neuropathic groups with mean CSA value above the predetermined 0.10cm(2) cut-off point. High-resolution ultrasonography is therefore useful to diagnose and follow up cases of elbow UNN.
Fulltext Reappraisal of bovril as a source of arginine in the arginine stimulation test for growth hormone deficiency

Loh HH, Norlela S, Nor Azmi K

Med J Malaysia, 2015 Jun;70(3):208-9.
PMID: 26248787 MyJurnal

The purpose of this case study is to report the use of oral Bovril (a food supplement which contains arginine) as an alternative test for growth hormone stimulation test. We performed oral Bovril test in 3 patients -- one with suspected growth hormone deficiency in whom insulin tolerance test could not be performed (subject A), one sex-matched control (subject B), and one with confirmed growth hormone deficiency (subject C). 14g/m(2) of oral Bovril was mixed with 150ml of warm water and was given to all three subjects. Blood for growth hormone was taken at baseline, and every 30 minutes till 150 minutes after ingestion of oral Bovril. The ingestion of oral Bovril showed a positive response in subjects A and B, with highest growth hormone levels of 28.4mIU/L and 42.0mIU/L respectively at 150 minutes. Subject C had suppressed growth hormone throughout the test. Oral Bovril is readily available and is a safe alternative for standard growth hormone stimulation test.
Fulltext Audit on management of eclampsia at Sultan Abdul Halim Hospital

Mohd Azri MS, Edahayati AT, Kunasegaran K

Med J Malaysia, 2015 Jun;70(3):142-7.
PMID: 26248775 MyJurnal

INTRODUCTION: Maternal mortality and morbidity from eclampsia continues to be seen around the globe. Local Key Performance Index on recurrence of eclamptic fits did not meet targets, thus this raised the issue whether the care provided adhered to the standard management for eclampsia.

METHODS: This clinical audit was conducted to assess and improve the quality of the service being offered to patient, particularly in managing eclampsia cases. It was conducted according to the audit cycle. It begins with the development of 12 standardized criteria for eclampsia management. First audit was conducted by retrospectively reviewing eclampsia cases from year 2008 till 2012. Strategies for changes were formulated and implemented following the results of the first audit. Second audit was conducted six months after the changes.

RESULTS: The overall incidence rate of eclampsia was 9.17 per 10,000 deliveries. A first seizure occurred during the antepartum period in 52.9% of cases (n=27), intrapartum in 24% (n=11) and postpartum in 21% of cases (n=13). Suboptimal care was mainly on delay of activation of Red Alert system and no treatment for uncontrolled blood pressure. Several strategies were implemented, mainly on improving working knowledge of the staffs and reengineering hospital Red Alert system. Positive achievements observed during the second audit, shown by a reduction in the number of patients with recurrence eclamptic fits and perinatal mortality rate.

CONCLUSION: Conducting an audit is essential to evaluate local performance against the standardized criteria. Improvement can be achieved with inexpensive solutions and attainable within a short period of time.
Study site: Sultan Abdul Halim Hospital, Sungai Petani, Kedah, Malaysia
Outcome of chemotherapy counseling by pharmacists on psychological effects and self esteem among oncology patients in a Government Hospital in Malaysia

Ummavathy P, Sherina MS, Rampal L, Siti Irma Fadhilah I

Med J Malaysia, 2015 Jun;70(3):131-41.
PMID: 26248774 MyJurnal

INTRODUCTION: Chemotherapy is the most common form of treatment among cancer patients. It is also known to cause many physical and psychological side-effects.
OBJECTIVE: This study developed, implemented and evaluated the outcome of a chemotherapy counseling module among oncology patients by pharmacists based on their psychological effects (depression, anxiety) and selfesteem.
METHODS: A randomized, single blind, placebo controlled study was conducted among 162 patients undergoing chemotherapy in a government hospital in Malaysia.
INTERVENTION: Counseling sessions were conducted using the 'Managing Patients on Chemotherapy' module for oncology patients undergoing chemotherapy at each treatment cycle.
OUTCOME: The outcome of repetitive chemotherapy counseling using the module was determined at baseline, first follow-up, second follow-up and third follow-up.
RESULTS: The findings revealed that there was significant improvement in the intervention group as compared to the control group with large effect size on depression (p = 0.001, partial η(2) = 0.394), anxiety (p = 0.001, partial η(2) = 0.232) and self-esteem (p = 0.001, partial η(2) = 0.541).
CONCLUSION: Repetitive counseling using the 'Managing Patients on Chemotherapy' module was found to be effective in improving psychological effects and self-esteem among patients undergoing chemotherapy.
Fulltext The burden of human influenza in Malaysia

Sam JIC

Med J Malaysia, 2015 Jun;70(3):127-30.
PMID: 26248773 MyJurnal

Seasonal and pandemic influenza causes considerable morbidity and mortality globally, but the burden of disease is understudied and underreported in developing countries such as Malaysia. Before considering the cost-effectiveness of introducing interventions such as vaccines to control influenza, it is imperative to determine clinical and socioeconomic impact of the disease. This review summarises the main available literature on human influenza in Malaysia, the possible reasons for the lack of study and awareness of influenza, and important knowledge gaps for future study.
Fulltext Post hysterectomy intravenous leiomyomatosis: multimodality imaging appearances

Teo YM, Anil G

Med J Malaysia, 2015 Jun;70(3):205-7.
PMID: 26248786

No abstract available.
Fulltext Individualised second line anti-tuberculous therapy for an extensively resistant pulmonary tuberculosis (XDR PTB) in East Malaysia

Muhammad Redzwan SR, Ralph AP, Sivaraman Kannan KK, William T

Med J Malaysia, 2015 Jun;70(3):200-4.
PMID: 26248785 MyJurnal

Clinical experience with extensively Drug Resistant tuberculosis (XDR-TB) has not been reported in Malaysia before. We describe the clinical characteristics, risk factors, progress and therapeutic regimen for a healthcare worker with XDR-TB, who had failed therapy for multidrug resistant TB (MDR TB) in our institution. This case illustrates the risk of TB among healthcare workers in high TB-burden settings, the importance of obtaining upfront culture and susceptibility results in all new TB cases, the problem of acquired drug resistance developing during MDR-TB treatment, the challenges associated with XDR-TB treatment regimens, the value of surgical resection in refractory cases, and the major quality of life impact this disease can have on young, economically productive individuals.
Fulltext A case of ear canal black pigment foreign body mimicking a melanoma

Pang EB, Pang KP

Med J Malaysia, 2015 Jun;70(3):198-9.
PMID: 26248784

Melanoma of the ear canal is extremely rare; due to its hidden area, most would present late in their history. We present the first case reported, of a black pigment foreign body mimicking a melanoma in the external auditory canal. A 14 year old Chinese male presented with right sided otalgia and itch. Otoscopic examination revealed an irregular black naevus in the right auditory canal. An intraoperative excision showed a black pigment foreign body giant cell reaction. Clinicians should be aware of the possibility of a foreign body granuloma of the ear canal that might mimic a melanoma.
Fulltext The effectiveness of psychological interventions among tinnitus sufferers: A review

Wan Suhailah WH, Mohd Normani Z, Nik Adilah NO, Azizah O, Aw CL, Zuraida Z

Med J Malaysia, 2015 Jun;70(3):188-97.
PMID: 26248783 MyJurnal

INTRODUCTION: The aim of this article was to review the types of psychological interventions for patients with tinnitus, professionals involved in giving the intervention, the effectiveness of each method of interventions and comparisons with non-psychological approaches in treating tinnitus.

MATERIALS AND METHODS: PubMed database searched.

RESULTS: Twenty one articles that employed randomized controlled trials design were included. Cognitive behavioural therapy (CBT) was the most common intervention conducted by the researchers. Clinical psychologists and trainee psychologists were the most professionals involved in the therapy. The length of therapy ranged from six weeks to three months.

DISCUSSION: Psychological interventions were more effective in reducing psychological impacts of tinnitus than non-psychological interventions such as the use of tinnitus maskers. Nevertheless, the combination of the treatments yielded more superior outcomes.

CONCLUSION: A simplified version of psychological intervention that can be implemented by other clinical professionals should be developed to treat tinnitus holistically to overcome the shortage number of clinical psychologists.
Fulltext Barlow's Repair: Light in the Dark Tunnel: A Case Report Could Omit 'Light in A Dark Tunnel'

Mohd Alkaf AL, Simon V, Taweesak C, Abdul Rahman I

Med J Malaysia, 2015 Apr;70(2):106-7.
PMID: 26162389

Barlow's disease has a complex pathology requiring reconstructive surgery. Despite the complicated surgery it holds a positive outcome. We report a successful case of Barlow's disease who underwent mitral valve reconstructive surgery at our centre. Post-operative echocardiography shows a well-functioning repaired mitral valve without significant mitral regurgitation.
Fulltext Histoplasmosis with Addisonian crisis: call for bird control

Hu AS, Hu AS, Hu CH

Med J Malaysia, 2015 Apr;70(2):104-5.
PMID: 26162388 MyJurnal

We report a case of disseminated histoplasmosis, initially diagnosed from gut nodule colonoscopically, along with evidence of lung disease. Subsequently he developed Addisonian crisis due to adrenal involvement. Lessons were learnt from the importance of detailed history-personal and social/family, as well as psychosocial aspects of illness. Public health measures to reduce bird dropping (and thus possibility of histoplasmosis) are discussed.

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