Displaying all 18 publications

  1. Jarmin, R., Othman, H., Zuhdi, Z., Mohamad, I.S., Ahmad, A.W., Ariffin, A.C.
    Background: Morbidity post hepatectomy still remain persistent throughout decades compared to other
    surgery. Modern approach have been introduced to improve safety and reduce morbidity whilst at the same
    time enhance patient recovery. Thus, enhanced recovery after surgery or fast track recovery program for
    liver resection was initiated.

    Objective: The aim of this study was to achieve discharge by postoperative
    day 3 for minor resection and day 5 for major resection.

    Design and Setting: This is a prospective study
    conducted in Hospital Universiti Kebangsaan Malaysia (HUKM) from September 2014 till April 2015.

    and Methods: All patients undergoing open liver resection were included in the study. They were then
    managed post operatively according to ERAS protocol that was drawn up based on previous studies. Patient’s
    demographics data, intra operative parameters, postoperative complications and adherence to
    postoperative recovery protocol were recorded.

    Results: Seventeen patients (7 major and 10 minor
    resection) were recruited. The mean length of hospital stay for minor resection was 5.9 and major resection
    was 9.6 .With regards to the targets, 4 out of 10 (40%)patients in minor resection group and 4 out 7 (57.1%)
    in the major group were discharged on time. 9 patients had postoperative complications with no mortality
    recorded. In terms of the ERAS protocol targets, the PCA morphine discontinuation target was achieved in
    15 patients (88.3%) ,nasogastric tube removal (13 patients -76.5%) , urinary cathether removal (6 patients -
    35.3%), abdominal drains removal (9 patients-52.9%) and resumption of full diet was achieved by 82.4% (14

    Conclusion: From these overall achievement, most of our targets have been met and this shows
    that our ERAS protocol is safe to be applied to patient undergoing hepatectomy.

    Limitations: Some patients
    had achieved their target but not discharged for unknown reason.
  2. Shabeeb F, Hairol AO, Jarmin R
    Indian J Surg, 2010 Jul;72(Suppl 1):341-3.
    PMID: 23133292 DOI: 10.1007/s12262-010-0077-5
    Amyand's hernia is a rare condition in which the appendix is positioned in the inguinal hernia sac. Mucinous cysadenoma of the appendix is rather extremely rare. We report a case of a mucinous cystadenoma of the appendix which presented as an incarcerated right indirect inguinal hernia (Amyand's hernia).
  3. Sallapan S, Abu Bakar NZ, Jarmin R, Masir N, Mohammed F
    Malays J Pathol, 2018 Dec;40(3):359-371.
    PMID: 30580370
    INTRODUCTION: Primary pancreatic lymphomas are extremely rare. Clinically, primary pancreatic lymphoma mimics symptoms of carcinoma of the pancreatic head. Clinical and radiological features may overlap with other pancreatic conditions such as carcinoma, neuroendocrine tumours and autoimmune pancreatitis.

    CASE REPORT: We report a case of a 75-year-old man who presented with symptoms of obstructive jaundice. Ultrasonography and computed tomography (CT) showed an ill-defined lobulated soft tissue lesion at the head/uncinate process of the pancreas measuring 4.5 x 4.9 x 5.8 cm. The patient underwent pancreaticoduodenectomy for suspected pancreatic head/uncinate process carcinoma. Histopathology and immunohistochemical assessment of the pancreatic lesion established the diagnosis of a low-grade follicular lymphoma.

    DISCUSSION: Clinical and imaging features of primary pancreatic lymphoma may often overlap with pancreatic carcinoma. There is a value of obtaining preoperative tissue diagnosis such as tissue biopsy and fine needle aspiration (FNA) cytology with or without flow cytometry to make an accurate diagnosis of non-Hodgkin lymphoma and alleviate the need of more radical surgery in pancreatic lymphoma.

  4. Mohamad MA, Jarmin R, Md Pauzi SH
    Malays J Pathol, 2020 Dec;42(3):455-459.
    PMID: 33361729
    Schwannomas are mesenchymal tumors that are characteristically benign and slow growing, which originate from any nerve with Schwann cell sheath. Gastrointestinal schwannomas are rare with distinct morphologic features as compared to schwannomas of soft tissue or central nervous system. A 77-year-old male patient was diagnosed with gastrointestinal stromal tumor based on radiological findings and clinical impression when he presented with worsening abdominal discomfort and pain. He underwent distal gastrectomy however histopathological examination of the tumour revealed schwannoma. This case report presents a rare case of a symptomatic gastric schwannoma, whose definitive diagnosis was established by histopathological and immunohistochemical findings postoperatively.
  5. Jarmin R, Alwi RI, Shaharuddin S, Salleh KM, Gunn A
    Asian J Surg, 2004 Oct;27(4):342-4.
    PMID: 15564193
    A young man with HIV presented with biliary peritonitis secondary to spontaneous common bile duct perforation. Investigation revealed that the perforation was due to Mycobacterium tuberculosis. Tuberculosis of the bile duct is uncommon and usually presents with obstructive jaundice due to stricture. Bile duct perforation due to tuberculosis is extremely rare. Its management is discussed.
  6. Jarmin R, Azman A, Rahim R, Kosai NR, Das S
    Acta Med Iran, 2012;50(11):782-4.
    PMID: 23292632
    Intussusception is common cause of bowel obstruction in the paediatric age group compared to the elderly population. Many times, the diagnosis may be difficult because of asymptomatic nature of this bowel disorder. We hereby describe the case of a 75-year-old male who presented with lethargy, weakness, loss of movement in the joints and was found to be anemic. The haemoglobin level was low so he was transfused with packed cells. On gastrointestinal (GI) endoscopy, upper GI bleed was observed. A mass was observed beyond ampulla at the 2nd and 3rd part of the duodenal junction. Computerized tomography (CT) scan also showed a mass at the head of pancreas and the lesion at the left lung. In view of persistent bleed, 'Whipple's procedure' was performed. Histopathological examination showed small cell carcinoma of the lungs with metastasis to the pancreas and the jejunum. We here discuss the case of intussusception with intestinal metastasis which presented with gastrointestinal bleeding.
  7. Cheong KL, Roohi S, Jarmin R, Sagap I, Tong SHY, Qureshi A
    Med J Malaysia, 2000 Dec;55(4):464-6.
    PMID: 11221158
    Colonoscopy is an integral part of the clinician armamentarium in the diagnosis of colorectal cancer and its precursor, the adenoma. Polypoid lesions when identified can be excised at colonoscopy and in turn reduce the risk of colorectal cancer. We prospectively evaluated the yield of colorectal cancer and adenomatous polyps by indication for colonoscopy over a one-year period. A total of 375 colonoscopies were carried out. The more common indications of colonoscopy were rectal bleeding, abdominal pain, surveillance of colorectal cancer and altered bowel habit. The highest yield for cancer was for rectal bleeding with 12.5% while surveillance of patients with a history of polyps yielded the highest percentage of new polyps. We conclude that rectal bleeding as an indication for colonoscopy yielded the highest number of cancers.
  8. Chik I, Kelly EG, Jarmin R, Imran FH
    Wounds, 2016 Oct;28(10):360-368.
    PMID: 27768574
    Negative pressure wound therapy is a widely used method of wound dressing with various commercially available brands. The authors created the Hanikoda Method (HM) for effective wound bed preparation or definite wound closure.
  9. Jee SL, Jarmin R, Lim KF, Raman K
    Asian J Surg, 2018 Jan;41(1):47-54.
    PMID: 27530927 DOI: 10.1016/j.asjsur.2016.07.010
    BACKGROUND: In patients with acute biliary pancreatitis (ABP), cholecystectomy is mandatory to prevent further biliary events, but the precise timing of cholecystectomy for mild to moderate disease remain a subject of ongoing debate. The aim of this study is to assess the outcomes of early versus delayed cholecystectomy. We hypothesize that early cholecystectomy as compared to delayed cholecystectomy reduces recurrent biliary events without a higher peri-operative complication rate.

    METHODS: Patients with mild to moderate ABP were prospectively randomized to either an early cholecystectomy versus a delayed cholecystectomy group. Recurrent biliary events, peri-operative complications, conversion rate, length of surgery and total hospital length of stay between the two groups were evaluated.

    RESULTS: A total of 72 patients were enrolled at a single public hospital. Of them, 38 were randomized to the early group and 34 patients to the delayed group. There were no differences regarding peri-operative complications (7.78% vs 11.76%; p = 0.700), conversion rate to open surgery (10.53% vs 11.76%; p = 1.000) and duration of surgery performed (80 vs 85 minutes, p = 0.752). Nevertheless, a greater rate of recurrent biliary events was found in the delayed group (44.12% vs 0%; p ≤ 0.0001) and the hospital length of stay was longer in the delayed group (9 vs 8 days, p = 0.002).

    CONCLUSION: In mild to moderate ABP, early laparoscopic cholecystectomy reduces the risk of recurrent biliary events without an increase in operative difficulty or perioperative morbidity.

  10. Jailani RF, Kosai NR, Yaacob NY, Jarmin R, Sutton P, Harunarrashid H, et al.
    Clin Ter, 2014;165(6):294-8.
    PMID: 25524184 DOI: 10.7417/CT.2014.1771
    BACKGROUND AND OBJECTIVE: To compare the outcome of transarterial angioembolization (TAE) and surgery with endoscopically unmanageable non-variceal hemorrhage of the upper gastrointestinal tract.

    MATERIALS AND METHODS: A case note review of all patients treated for non-variceal upper gastrointestinal bleeding from January 2006 till January 2012 was performed.

    RESULTS: Fifty-four of 667 patients with non-variceal bleeding did not respond to endoscopic treatment. Nine of the 54 patients had incomplete data, leaving 45 patients in the study; 24 had angiography and another 21 had surgery. The two groups were broadly similar in terms of relevant clinical variables. Nineteen of 24 having angiography had embolisation. Re-bleeding recurred in 8 patients (33%) in the TAE group and 6 patients (28.6%) in the surgery group (p = 0.28). There was no statistically significant difference in post procedural complications (81% vs 62.5%, p = 0.17), 30-day mortality (33% vs 29.1%, p = 0.17 ) units of blood transfused (12.24 vs 8.92, p = 0.177) and mean hospital stay (30.7 vs 22.9 days, p = 0.281) observed in patients undergoing surgery as compared to TAE.

    CONCLUSIONS: TAE and surgery have similar outcomes in patients with endoscopically unmanageable non-variceal upper gastrointestinal haemorrhage.
  11. Jarmin R, Idris MA, Shaharuddin S, Nadeson S, Rashid LM, Mustaffa WM
    Asian J Surg, 2006 Jul;29(3):149-52.
    PMID: 16877213
    Obstructed rectal endometriosis is an uncommon presentation. The clinical and intraoperative presentation may present as malignant obstruction. The difficulty in making the diagnosis may delay the definitive management of the patient. We report a unique case of rectal endometriosis mimicking malignant rectal mass causing intestinal obstruction and discuss the management of the case.
  12. Tan JH, Mohamad Y, Imran Alwi R, Henry Tan CL, Chairil Ariffin A, Jarmin R
    Injury, 2019 May;50(5):1125-1132.
    PMID: 30686543 DOI: 10.1016/j.injury.2019.01.027
    BACKGROUND: Most trauma mortality prediction scores are complex in nature. GAP (Glasgow Coma Scale, Age, Systolic blood pressure) and mGAP (mechanism, Glasgow Coma Scale, Age, Systolic blood pressure) scores are relatively simple scoring tools. However, these scores were not validated in low and middle income countries including Malaysia and its accuracies are influenced by the fluctuating physiologic parameters. This study aims to develop a relevant simplified anatomic trauma scoring system for the local trauma patients in Malaysia.

    METHOD: A total of 3825 trauma patients from 2011 to 2016 were extracted from the Hospital Sultanah Aminah Trauma Surgery Registry. Patients were split into a development sample (n = 2683) and a validation sample (n = 1142). Univariate analysis is applied to identify significant anatomic predictors. These predictors were further analyzed using multivariable logistic regression to develop the new score and compared to existing score systems. The quality of prediction was determined regarding discrimination using sensitivity, specificity and receiver operating characteristic [ROC] curve.

    RESULTS: Existing simplified score systems (GAP & mGAP) revealed areas under the ROC curve of 0.825 and 0.806. The newly developed HeCLLiP (Head, cervical spine, lung, liver, pelvic fracture) score combines only five anatomic components: injury involving head, cervical spine, lung, liver and pelvic bone. The probabilities of mortality can be estimated by charting the total score points onto a graph chart or using the cut-off value of (>2) with a sensitivity of 79.2 and specificity of 70.6% on the validation dataset. The HeCLLiP score achieved comparable values of 0.802 for the area under the ROC curve in validation samples.

    CONCLUSION: HeCLLiP Score is a simplified anatomic score suited to the local Malaysian population with a good predictive ability for trauma mortality.

  13. Muniandy J, Azman A, Murugasan V, Alwi RI, Zuhdi Z, Jarmin R, et al.
    Ann Med Surg (Lond), 2021 Aug;68:102573.
    PMID: 34354831 DOI: 10.1016/j.amsu.2021.102573
    Background: The rate of surgical site infection (SSI) differ with variable nature with appendicitis with a global incidence of up to 11%. Several randomised trials describe a significant reduction in incisional SSI using wound edge protectors (WEP), mainly in elective procedures. This study was designed to analyse WEP use in emergency open appendicectomy.

    Method: This randomised controlled trial enrolled 200 patients who underwent emergency open appendicectomy. Permuted block randomisation was used to assign subjects to either mechanical retraction or double ring WEP. The primary endpoints were SSI rates and cost analysis between the methods.

    Results: The incidence of SSI was similar, n = 7 (7.4%) in the control group and n = 8 (8.4%) in the WEP group, and demonstrates no statistically significant difference (p > 0.05). Cost analysis showed a statistically significant (p 

  14. Boo HS, Chik I, Ngiu CS, Lim SY, Jarmin R
    Am J Case Rep, 2018 Aug 23;19:998-1003.
    PMID: 30135416 DOI: 10.12659/AJCR.909717
    BACKGROUND The esophagus can be affected by a variety of disorders that may be primary or secondary to another pathologic process, but the resulting symptoms are usually not pathognomonic for a specific problem, making diagnosis and further management somewhat challenging. High resolution impedance manometry (HRiM) has established itself as a valuable tool in evaluating esophageal motility disorder. HRiM is superior in comparison with conventional water perfused manometric recordings in delineating and tracking the movement of functionally defined contractile elements of the esophagus and its sphincters, and in distinguishing the luminal pressurization of spastic esophageal contraction from a trapped bolus. Making these distinctions can help to identify achalasia, distal esophageal spasm, functional obstruction, and subtypes according to the latest Chicago Classification of Esophageal Motility Disorders version 3.0. CASE REPORT We report a case series of 4 patients that presented with dysphagia; and with the ancillary help of the HRiM, we are able to diagnose esophageal motility disorder and evaluate its pathogenetic mechanism. This approach aids in tailoring each management individually and avoiding disastrous mismanagement. CONCLUSIONS From the series of case reports, we believe that HRiM has an important role to play in deciding appropriate management for patients presenting with esophageal motility disorders, and HRiM should be performed before deciding on management.
  15. Tan TL, Salleh SA, Che Man Z, Tan MHP, Kader R, Jarmin R
    Medicina (Kaunas), 2022 Dec 05;58(12).
    PMID: 36556993 DOI: 10.3390/medicina58121789
    Background and Objectives: The objective of this study is to examine the effect of the BNT162b2 vaccine on systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) before and 15 min after two doses that were given 21 days apart. Materials and Methods: This active surveillance study of vaccine safety was conducted on 15 and 16 March (for the first dose) and 5 and 6 April (for the second dose) 2021 in an academic hospital. For both doses, SBP, DBP, MAP, and PP levels were measured before and 15 min after both doses were given to healthcare workers over the age of 18. The results of the study were based on measurements of the mean blood pressure (BP), the mean changes in BP, and the BP trends. Results: In total, 287 individuals received the vaccine. After the first dose, 25% (n = 72) of individuals had a decrease in DBP of at least 10 mmHg (mean DBP decrease: 15 mmHg, 95% CI: 14-17 mmHg), and after the second dose it was 12.5% (mean DBP decrease: 13 mmHg, 95% CI: 12-15 mmHg). After the first dose, 28.6% (n = 82) had a PP that was wider than 40 mmHg. After the first dose, 5.2% and 4.9% of the individuals experienced an increase or decrease in SBP, respectively, of more than 20 mmHg. After the second dose, the SBP of 11% (n = 32) decreased by at least 20 mmHg. Conclusions: Improved understanding of vaccine effects on BP may help address vaccine hesitancy in healthcare workers.
  16. Rahman FA, Naidu J, Ngiu CS, Yaakob Y, Mohamed Z, Othman H, et al.
    Asian Pac J Cancer Prev, 2016;17(8):4037-41.
    PMID: 27644658
    BACKGROUND: Hepatocellular carcinoma (HCC) is a common cancer that is frequently diagnosed at an advanced stage. Transarterial chemoembolisation (TACE) is an effective palliative treatment for patients who are not eligible for curative treatment. The two main methods for performing TACE are conventional (c-TACE) or with drug eluting beads (DEB-TACE). We sought to compare survival rates and tumour response between patients undergoing c-TACE and DEB-TACE at our centre.

    MATERIALS AND METHODS: A retrospective cohort study of patients undergoing either treatment was carried out from January 2009 to December 2014. Tumour response to the procedures was evaluated according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Kaplan-Meier analysis was used to assess and compare the overall survival in the two groups.

    RESULTS: A total of 79 patients were analysed (34 had c-TACE, 45 had DEB-TACE) with a median follow-up of 11.8 months. A total of 20 patients in the c-TACE group (80%) and 12 patients in the DEB-TACE group (44%) died during the follow up period. The median survival durations in the c-TACE and DEB-TACE groups were 4.9 ± 3.2 months and 8.3 ± 2.0 months respectively (p=0.008). There was no statistically significant difference noted among the two groups with respect to mRECIST criteria.

    CONCLUSIONS: DEB-TACE demonstrated a significant improvement in overall survival rates for patients with unresectable HCC when compared to c-TACE. It is a safe and promising approach and should potentially be considered as a standard of care in the management of unresectable HCC.

  17. Pérez-Cuadrado Robles E, Lakhtakia S, Othman H, Tewethia HV, Yaacob N, Jarmin R, et al.
    Rev Esp Enferm Dig, 2022 Jan 11.
    PMID: 35012320 DOI: 10.17235/reed.2022.8451/2021
    Introduction Biodegradable stents of various designs are reportedly used in pancreato-biliary conditions with promising results. Their major advantage is the avoidance of a repeat endoscopic procedure for stent removal thereby reducing overall cost along with ERCP associated adverse events. To evaluate the feasibility and safety of a new biodegradable stent in patients with pancreato-biliary diseases. Methods Prospective multicenter pilot study. All consecutive patients 18 years-old who underwent biliary or pancreatic stenting using the new biodegradable Archimedes stent were included. There were three biodegradation profiles. Technical and clinical success, feasibility and safety were assessed during a pre-established follow-up schedule. Results Fifty-three patients (mean age: 48.54±19.29, 66% male) having biliary (n=29, 54.7%%) or pancreatic (n=24, 45.3%) indications were included. The distribution of stents used according to degradation properties were as follows: fast (n=11, 20.8%), medium (n=16, 30.2%) and slow (n=26, 49.1%). The technical and clinical success were 100% and 77.8%. Thirty-five patients were followed for a median of 26 weeks (range: 4-56, 66%). There were 9 procedure-related adverse events (17%), all mild, including one uneventful stent-related event (external migration). Conclusion The biodegradable Archimedes stent placement is feasible and safe in pancreato-biliary diseases.
  18. Tan YC, Mustangin M, Rosli N, Wan Ahmad Kammal WSE, Md Isa N, Low TY, et al.
    Cryobiology, 2024 Mar;114:104843.
    PMID: 38158171 DOI: 10.1016/j.cryobiol.2023.104843
    Coolant-assisted liquid nitrogen (LN) flash freezing of frozen tissues has been widely adopted to preserve tissue morphology for histopathological annotations in mass spectrometry-based spatial proteomics techniques. However, existing coolants pose health risks upon inhalation and are expensive. To overcome this challenge, we present our pilot study by introducing the EtOH-LN workflow, which demonstrates the feasibility of using 95 % ethanol as a safer and easily accessible alternative to existing coolants for LN-based cryoembedding of frozen tissues. Our study reveals that both the EtOH-LN and LN-only cryoembedding workflows exhibit significantly reduced freezing artifacts compared to cryoembedding in cryostat (p 
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