MyMedR

Fulltext Asymptomatic chronically retained gauze in the pelvic cavity

Imran Y, Azman MZN

Med J Malaysia, 2005 Aug;60(3):358-9.

Cases of retained surgical guaze are rarely reported because of medico-legal and professional implications. Retained gauze for a period of more than 10 years is even rarer. A case of retained surgical gauze for 11 years, an accidental finding from a plain radiograph of a patient who had sustained proximal femoral fracture, is reported. A review of other reported cases is presented.

Fulltext Hoarseness in an older adult: Ortner syndrome

Koh WJ, Azman M

Malays Fam Physician, 2021 Nov 30;16(3):129-131.

PMID: 34938406 DOI: 10.51866/tyk1244

A detailed examination in an older adult presenting with chronic hoarseness is mandatory to exclude an upper aerodigestive tract malignancy. We describe a 71-year-old chronic smoker with essential hypertension who presented with hoarseness and vocal fatigue for 5 months. Laryngoscopic examination showed left vocal fold paralysis with phonation gap. No growth was seen at all laryngeal and hypopharyngeal subsites. The rest of the head and neck, chest, upper limbs and neurovascular examination were unremarkable. A plain chest radiograph demonstrated a cause for the left recurrent laryngeal nerve palsy. The diagnosis, complications and definitive management of the underlying cause and resultant voice problem will be discussed.

Fulltext Subglottic Hemangioma: A Hidden Mass Presenting in an Unusual Age Group

Rajendran T, Azman M

Cureus, 2023 Apr;15(4):e38293.

PMID: 37255907 DOI: 10.7759/cureus.38293

Subglottic hemangiomas are rare in adulthood. The presence of the lesion in the subglottic region makes it even more unusual. Moreover, these lesions do not have a typical course and involution changes as seen in the infantile forms. An elderly female initially came with a brief history of dyspnea and symptoms of upper respiratory tract infection. The patient also complained of a change of voice and noisy breathing, with a recent history of intubation following COVID-19 pneumonia and late-onset bronchial asthma. Flexible nasopharyngolaryngoscopy showed a mass below the vocal folds, which was seen to arise from the posterior subglottic region. The patient eventually underwent endoscopic excision of the lesion under general anesthesia and recovered well. Symptoms of hoarseness and stridor, along with a history of intubation, should raise a high index of suspicion for laryngeal diseases. A delay in the diagnosis of an obstructing lesion in the subglottis occurs in the presence of a confounding lung infection and overlap of clinical features with those of bronchial asthma. Surgical excision is required not only to alleviate obstructive symptoms but also to rule out malignancy.

Fulltext Three squamous cell carcinomas of different sites in three years: A mere coincidence?

Azman M, Mohd Yunus MR

Indian J Cancer, 2015 Apr-Jun;52(2):201-2.

PMID: 26853404 DOI: 10.4103/0019-509X.175817

A proposed model for postgraduate entrance evaluation amidst the COVID-19 pandemic

Azman M, Hamizan AW, Salina H

Med J Malaysia, 2021 08;76(Suppl 4):49-51.

PMID: 34558560

The COVID-19 pandemic has affected the entrance evaluation for postgraduate studies (PGS) in various medical specialties. The PGS in otorhinolaryngology (ORL) continue to be relevant amidst the pandemic, with more than 150 applicants this year. We share here our recent experiences in managing ORL entrance examinations during the height of the COVID-19 pandemic. It is possible to conduct virtually the multi-institutional, multi-faceted evaluation for PGS entrance during pandemic situations whilst conforming to the already established format and standards.

Fulltext Alarming triad of progressive hoarseness in a male smoker

Za'im NAN, Azman M

Malays Fam Physician, 2021 Nov 30;16(3):119-122.

PMID: 34938403 DOI: 10.51866/cr1163

Hoarseness accounts for 1% of all consultations in primary care. Suspicion of malignancy should be considered in individuals with risk factors presenting with unexplained hoarseness lasting more than two weeks. A significant number of patients with laryngeal cancer present at an advanced stage due to lack of awareness regarding vocal health. It is important to educate both the public and primary care health providers concerning laryngeal cancer. We present the case of an 81-year- old male smoker who presented to us with a six-month history of progressive hoarseness. He was initially treated in two primary and one secondary care centres, where a diagnosis of laryngeal cancer was not considered. Careful assessment in our centre managed to determine a diagnosis of T3N0M0 glottic carcinoma. We will discuss this alarming triad of progressive hoarseness in a male smoker to help primary care physicians streamline their thoughts and identify red flags in a hoarse patient.

Therapeutic drug monitoring of gentamicin: a 6-year follow-up audit

Ismail R, Haq AH, Azman M, Rahman AF

J Clin Pharm Ther, 1997 Feb;22(1):21-5.

PMID: 9292398

In 1984 a therapeutic drug monitoring (TDM) service was established in Hospital Universiti Sains Malaysia (HUSM) and gentamicin concentrations were measured and used to design optimal regimens for the antibiotic. In this study we report on a 6-year follow-up audit since our first assessment of the service.

Retained haemodialysis-catheter guidewire in the head and neck: a multidisciplinary team approach

Xiao Hong C, Abd Wahab S, Azman M

BMJ Case Rep, 2020 Oct 27;13(10).

PMID: 33109696 DOI: 10.1136/bcr-2020-236484

Penetrating foreign body in the head and neck can be catastrophic from injury to the constellation of vascular and neural structures in the neck. Early recognition and prompt surgical intervention is imperative to save lives. Herein, we present an unusual case of iatrogenic foreign body-a coiled guidewire embedded in the deep neck space. The complications, radiological investigation and multidisciplinary surgical management are further discussed.

Congenital Midline Tongue Base Mass in An Infant: Lingual Hamartoma

Fadzilah N, Azman M, See GB

J Clin Diagn Res, 2016 Sep;10(9):MD01-MD03.

PMID: 27790477

Lingual hamartoma is a rare finding of congenital midline posterior tongue mass. The lesion may be seen as a single anomaly or maybe associated with syndrome especially the Oral Facial Digital Syndrome (OFDS). Here, we report an otherwise normal and healthy two-month-old boy with a congenital midline base of tongue mass presented with snoring and episodic vomiting since the age of 1 month. Tumour excision from the area of foramen of caecum recovered a pinkish pedunculated tumour. Histopathology examination confirmed the diagnosis of leiomyomatous lingual hamartoma. Differential diagnosis, especially for midline tongue mass and other paediatric tongue lesions are discussed. We also discuss the epidemiology, histopathologic features, treatment and prognosis of lingual hamartoma based on the literature review.

The end of tracheostomal stenosis? Introducing the fish mouth technique

Gendeh HS, Azman M, Mat Baki M, Mohamed AS

J Laryngol Otol, 2021 Nov 25.

PMID: 34819184 DOI: 10.1017/S0022215121003820

BACKGROUND: Post-laryngectomy tracheostomal stenosis is common and often results in an inadequate airway. Several techniques have been described to minimise tracheostomal stenosis. The star technique involves an 'X' incision with four flaps sutured into the trachea. The petal technique involves two inferior flaps on either side being sutured into the trachea. The authors combined the star and petal techniques, resulting in an innovative fish mouth technique.

METHODS AND RESULTS: This innovation involves two lateral skin flaps being sutured into an incision on either side of the lateral wall of the trachea. This results in an elongated, broadened and elliptical tracheostoma, mimicking that of a fish mouth.

CONCLUSION: Benefits of the fish mouth technique include adequate stoma size for respiration, easier clearing of secretions, self-sufficiency without a stent, easier cleaning of a tracheoesophageal voice prosthesis, and stoma occlusion for voice production. The fish mouth technique is easily reproducible and suitable for those with a voice prosthesis.

Fulltext Insulin resistance using HOMA model in obstructive sleep apnea: a cross sectional study

Azman M, Sani A, Kamaruddin NA

Ann Saudi Med, 2014;34(6):476-81.

PMID: 25971819 DOI: 10.5144/0256-4947.2014.476

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) is a common disease affecting middle-aged patients and is associated with significant cardiovascular, cerebrovascular, and metabolic complications. Current evidences show inconclusive association between OSA and insulin resistance (IR). This study aims to examine the possible correlation between OSA parameters and IR.

DESIGN AND SETTINGS: This was a cross-sectional study to examine the association between OSA parameters and IR using homeostasis model assessment (HOMA) on patients who underwent polysomnogram (PSG) in a tertiary center between March 2011 and March 2012 (1 year).

PATIENTS AND METHODS: A total of 62 patients underwent PSG within the study period, of which 16 patients were excluded due to abnormal fasting blood sugar. Information on patients' medical illnesses, medications, and Epworth sleepiness scale (ESS) was obtained. Patients' body mass index (BMI), neck circumference, and waist circumference (WC) were measured. Blood samples were collected after 8 hours of fasting to measure HOMA-IR value. Overnight PSG was performed for all patients. Data was recorded and analyzed using SPSS, version 12.0 (SPSS Inc, Chicago, USA).

RESULTS: The prevalence of IR in OSA patients was 64.3%. There was significant correlation between OSA parameters (apnea-hypopnea index, ESS, BMI, and WC) and HOMA-IR with correlation coefficient of 0.529, 0.224, 0.261, and 0.354, respectively.

CONCLUSION: A linear correlation exists between OSA parameters and IR concluding a definite causal link between OSA and IR. IR screening is recommended in severe OSA patients.

Fulltext Better Safe Than Sorry: A Rare Case of a Laryngeal Foreign Body and the Unconventional Use of Cook® Airway

Musa MSH, Yeoh ZX, Azman M

Cureus, 2024 Jan;16(1):e52918.

PMID: 38406054 DOI: 10.7759/cureus.52918

Foreign body (FB) inhalation in the pediatric population is a common emergency referral in otolaryngology practice. Mismanagement can lead to significant morbidity or even mortality. Anesthesiologists conventionally use the Cook® airway exchange catheter (CAEC) during endotracheal tube exchange in the intensive care unit, but its usage as an oxygen conduit is beneficial in other airway procedures. A healthy two-year-old boy was brought to casualty for allegedly choking on a boneless chicken meat bolus during mealtime. The initial presentation showed that the child was comfortable with soft audible stridor without signs of respiratory distress. Bedside video laryngoscopy revealed a whitish FB in the proximity of the vocal cord. The patient was subjected to emergency direct laryngoscopy and bronchoscopy to retrieve the FB. Under general anesthesia, the true nature of FB was revealed, which was an embedded chicken bone into the laryngeal ventricle, causing a significant reduction of the rima glottis opening. CAEC was used to maintain oxygenation during the complex extraction process, and the child was discharged without any morbidity. Eyewitness history is an essential component in diagnosing FB inhalation in the pediatric population. Despite that, identifying potential difficulty is important to provide backup, especially in the case of unexpected events during managing airway emergencies.

Fulltext Guillain-Barré syndrome complicating dengue fever: Two case reports

Boo YL, Aris MAM, Chin PW, Sulaiman WAW, Basri H, Hoo FK

Ci Ji Yi Xue Za Zhi, 2015 11 17;28(4):157-159.

PMID: 28757747 DOI: 10.1016/j.tcmj.2015.09.007

Guillain-Barré syndrome is a rare neurological manifestation associated with dengue infection. More common antecedent infections include Campylobacter jejuni and Cytomegalovirus infection. Here, we report two cases of Guillain-Barré syndrome complicating dengue infection.

Wernicke Encephalopathy as the First Presentation of Neuromyelitis Optica Spectrum Disorder With Horizontal Nerve Palsy

Supahiah P, Thomas BHI, Zhen PC, Aris AM, Abdul-Jalil F, Din NM

J Neuroophthalmol, 2023 Dec 01;43(4):e293-e295.

PMID: 34924530 DOI: 10.1097/WNO.0000000000001444

Enteral glutamine supplementation in surgical patients with head and neck malignancy: A randomized controlled trial

Azman M, Mohd Yunus MR, Sulaiman S, Syed Omar SN

Head Neck, 2015 Dec;37(12):1799-807.

PMID: 24992652 DOI: 10.1002/hed.23839

Glutamine supplementation is a novel approach to perioperative nutritional management.

Fulltext Forequarter amputation of the upper extremity for musculoskeletal tumors: posterior approach revisited

Faisham WI, Zulmi W, Nor Azman MZ, Rhendra Hardy MZ

Med J Malaysia, 2006 Feb;61 Suppl A:57-61.

PMID: 17042232

Forequarter amputation entails surgical removal of entire upper extremity, scapula and clavicle. Several techniques of forequarter amputation have been described. The anterior approach has been the preferred technique of exploration of axillary vessels and brachial plexus. The posterior approach has been condemned to be unreliable and dangerous for most large tumor of the scapula and suprascapular area. We describe a surgical technique using posterior approach of exploration of major vessels for forequarter amputation of upper extremity in eight patients who presented with humeral-scapular tumor. There were six patients with osteosarcoma: three with tumor recurrent and three chemotherapy recalcitrant tumors with vessels involvement. One patient had massive fungating squamous cell carcinoma and another had recurrent rhabdomyosarcoma. Four patients had fungating ulcer and six patients had multiple pulmonary metastases at the time of surgery. The mean estimated blood transfusion was 900 ml (range 0-1600 ml) and two patients did not require transfusion. The duration of surgery ranged 2.5-6.0 hours (mean 3.8 hours). Two patients with known pulmonary metastases required post-operative intensive care monitoring. The mean duration of survival was 5.8 months. The posterior approach of exploring major vessels for forequarter amputation of upper extremity with musculoskeletal tumor is safe and reliable.

Fulltext Outcome of surgical treatment of pelvic osteosarcoma: hospital universiti sains malaysia experience

Ariff M, Zulmi W, Faisham W, Nor Azman M, Nawaz A

Malays Orthop J, 2013 Mar;7(1):56-62.

PMID: 25722809 MyJurnal DOI: 10.5704/MOJ.1303.018

We reviewed the surgical treatment and outcomes of 13 patients with pelvic osteosarcoma treated in our centre in the past decade. The study sample included 9 males and 4 females with a mean age of 28.1 years. Four patients had ileal lesions, five had acetabulum lesions, one had a ischiopubis lesion, and three had involvement of the whole hemipelvis. Seven patients presented with distant metastases at diagnosis. Limb salvage was performed in 6 patients and amputation in 7. In 60% of cases in the limb salvage surgery group, we attempted wide resection with positive microscopic margin compared to only 16.7% in the amputation group. Local recurrence was higher in the limb salvage group. Overall survival was 18 months for mean follow up of 14.8 months. Median survival was 19 months in the limb salvage group compared to 9 months in amputation group. The outcome of surgical treatment of pelvic osteosarcoma remains poor despite advancements in musculoskeletal oncology treatment.

Fulltext Saliva substitute mouthwash in nasopharyngeal cancer survivors with xerostomia: a randomized controlled trial

Marimuthu D, Han KM, Mohamad MSF, Azman M

Clin Oral Investig, 2021 May;25(5):3105-3115.

PMID: 33175253 DOI: 10.1007/s00784-020-03634-5

OBJECTIVES: Xerostomia is a prevalent sequelae among nasopharyngeal cancer (NPC) survivors; yet, effective treatment protocols have been elusive. This study was a prospective randomized clinical trial to compare the effects of saliva substitute mouthwash in nasopharyngeal cancer survivors with xerostomia, between two treatment arms, conducted in a tertiary center.

MATERIALS AND METHODS: This study measured the effects within 4 weeks in relation to summated xerostomia inventory (SXI) and unstimulated whole saliva (UWS). Patients randomized into the interventional arm were prescribed an immunologically active saliva substitute (IASS), while patients in the control arm were prescribed a non-immunologically active mouthwash as placebo.

RESULTS: The study population consisted of 94 patients. There was a significant difference in SXI difference (p < 0.0001) and UWS difference (p < 0.0001) between control and interventional arms. No harmful side effects associated with the use of either mouthwash encountered throughout the study duration.

CONCLUSION: IASS mouthwash significantly reduces subjective xerostomia scores measured using SXI and improves objective measurement of salivary flow using UWS among nasopharyngeal cancer survivors with xerostomia.

CLINICAL RELEVANCE: IASS is significantly more effective in improving subjective and objective xerostomia measurements compared to non-immunologically active mouthwash. Additionally, this treatment is very safe, with superior side effect profiles.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04491435.

Maximum vocal intensity as a primary outcome measure in unilateral vocal fold paralysis patients

Johari SF, Azman M, Mohamed AS, Baki MM

J Laryngol Otol, 2020 Dec;134(12):1085-1093.

PMID: 33308327 DOI: 10.1017/S0022215120002558

OBJECTIVE: To evaluate voice intensity as the primary outcome measurement when treating unilateral vocal fold paralysis patients.

METHODS: This prospective observational study comprised 34 newly diagnosed unilateral vocal fold paralysis patients undergoing surgical interventions: injection laryngoplasty or medialisation thyroplasty. Voice assessments, including maximum vocal intensity and other acoustic parameters, were performed at baseline and at one and three months post-intervention. Maximum vocal intensity was also repeated within two weeks before any surgical interventions were performed. The results were compared between different time points and between the two intervention groups.

RESULTS: Maximum vocal intensity showed high internal consistency. Statistically significant improvements were seen in maximum vocal intensity, Voice Handicap Index-10 and other acoustic analyses at one and three months post-intervention. A significant moderate negative correlation was demonstrated between maximum vocal intensity and Voice Handicap Index-10, shimmer and jitter. There were no significant differences in voice outcomes between injection laryngoplasty and medialisation thyroplasty patients at any time point.

CONCLUSION: Maximum vocal intensity can be applied as a treatment outcome measure in unilateral vocal fold paralysis patients; it can demonstrate the effectiveness of treatment and moderately correlates with self-reported outcome measures.

Fulltext Obstructive retrosternal goitre mimicking severe bronchial asthma in pregnancy

Loo GH, Wan Mat WR, Muhammad R, Azman M

BMJ Case Rep, 2019 Aug 04;12(8).

PMID: 31383679 DOI: 10.1136/bcr-2019-229763

Acute airway obstruction in pregnancy remains a challenge to manage. Failure of appropriate and timely airway management may lead to maternal morbidity and mortality such as aspiration pneumonitis or worst hypoxaemic cardiopulmonary arrest. 1 As pregnancy may exacerbate asthma attacks, parturient presenting with wheezing or shortness of breath will commonly be treated as suffering from an asthmatic attack. 2 However, it is important to note other possible differential diagnoses. Thyroid disease is relatively common in women of childbearing age. The thyroid gland undergoes several changes during pregnancy, which may lead to altered function as well as gland enlargement and cause upper airway obstruction and symptoms similar to a bronchial asthma attack. 3 4 With that in mind, we report a case of a parturient with long-standing goitre in her second trimester who presented to our institution with acute respiratory symptoms and cardiopulmonary arrest.

Displaying publications 1 - 20 of 54 in total