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Fulltext Ultrasound Subcostal Approach Transversus Abdominis Plane Block in Morbidly Obese Patient

Nelbon Giloi, Liew, Constance Sat Lin, Payus, Alvin Oliver, Mac Guad, Rhanye, Murugaiah, Chandrika, Soe, May Zaw, et al.

Borneo Journal of Medical Sciences, 2019;13(3):43-47.
MyJurnal

As general population of obese patients in Malaysia rapidly increases, more obese patients are requiring anaesthesia for various operative procedures. Obesity is associated with anatomical and physiological differences and co-morbidities that influence on the choices of anaesthesia care. A surgical case with general anaesthesia is used as a basis of discussion. A 37-year-old female, history of untreated hypertension and gastrooesophageal reflux disease (GORD), BMI of 41 admitted for laparoscopic cholecystectomy for symptomatic cholelithiasis under general anaesthesia. She presented with pain at the upper right abdomen and associated with bloated abdomen, nausea and vomiting after intake of meals. General anaesthesia and right ultrasound-guided transversus abdominis plane (TAP) block for abdominal wall blocks via subcostal approach was performed. Operation was removal gallstones in the common bile duct via laparoscopic approach. Post-operation patient was extubated successfully. She was prescribed paracetamol 1g 4 hourly and started on fentanyl patient-controlled analgesia (PCA) for next 2 days. In this case report, there is the description of the application of TAP block which when used in obese abdominal surgical procedure, can provide excellent postoperative pain relief, early mobilization and recovery.
Fulltext Olfactory dysfunction: a diagnostic symptom of COVID-19

Shaila Kabir, A B M Tofazzal Hossain, Liew, Constance Sat Lin, M. Tanveer Hossain Parash, Chandrika Murugaiah, A. H. M. Delwar, et al.

Borneo Journal of Medical Sciences, 2021;15(2):3-9.
MyJurnal

Besides the common respiratory symptoms or viral pneumonia, COVID-19 is also presented with different neurological symptoms. Olfactory dysfunction (OD) or impairment of the sense of smell is one of the common neurological symptoms being reported in infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The severity varies from anosmia to microsmia or hyposmia. OD could have a potential early screening and diagnostic value besides other neurological and common respiratory symptoms. In our descriptive concise review, we aimed to elicit the manifestation of olfactory dysfunction as an early predictor of SARS-CoV-2 infection. We are also aiming to establish, OD as a quick and reliable assessment tool of COVID-19 risk, among the healthcare workers and contact tracers, which can justify self-quarantine of the person as well as recommendation for testing on a priority basis. We have also focused on, any effect to produce this symptom by the drug used for treatment in COVID-19, and if the old age of the patient showing any extra influence to develop OD in COVID-19.
Fulltext An Assessment of the Use of RAn Assessment of the Use of Rotary Wing Aircraft for Primary and Medical Emergency Care Service – Sabah State Experience otary Wing Aircraft for Primary and Medical Emergency Care Service – Sabah State Experience

Lim, Jac Fang, Mohammad Saffree Jeffree, Nelbon Gilo, Mohd Yusof Ibrahim, Liew, Constance Sat Lin, Simson Gunsalam, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(111):42-48.
MyJurnal

Introduction: Rotary wing aircraft (RWA) or the helicopter has been used in Primary Health Care and Medical Emergency Services in the state of Sabah since the seventies. The use of RWA has distinct advantages in terms of speed, ability to access remote areas and in the transportation of patients to tertiary care. Single engine RWA was used for the last forty years which has now been replaced with twin engine RWA. The objective of this study is to compare the different type of RWA which was used and the suitability of
these machines for health services in Sabah. Methods: A detailed analysis and comparison of manufacturers’ specifications which include the performance, size, the number of power plant, passenger capacity,
safety track record, aircraft manufacturer’ s support, maintenance and operational costs of different types of RWA available in Sabah taking into account current and future demands as well as functional requirements and
the capability of the aircraft service providers were considered. Results: The choice of aircrafts depends on the type of service and its suitability. From the assessment, a single engine RWA would be adequate to support the
current and future need in Sabah. Conclusion: Adequate technical knowledge in choosing the type of aircraft to provide an effective health service is vital. These also contribute to the cost effectiveness of the program and significantly determine efficiency of the service and the interest of the rural people with poor accessibility to health care.
Fulltext Wilms tumor presenting as small bowel obstruction in a neonate: A diagnostic challenge

Ahmed S, Nadarajan C, Ng CY, Teh YG, Abdul Muien MZ, Liew CSL

Radiol Case Rep, 2021 Oct;16(10):2908-2912.
PMID: 34401023 DOI: 10.1016/j.radcr.2021.06.058

Wilms tumor is the most common primary malignant renal tumor of childhood which usually presents between 2 and 6 years of age. Its presentation in the neonatal period is extremely rare and presenting with intestinal obstruction is perhaps unknown. We report a 2-day-old baby girl who manifested features of acute upper gastrointestinal obstruction with frequent post-feeding vomiting and abdominal distension. The initial abdominal radiograph showed abnormally displayed small bowel loops to the right hemiabdomen. Subsequent ultrasound and computed tomography scan of the abdomen detected a massive left renal mass. Left-sided nephrectomy was performed, and histopathology demonstrated left-sided Wilms tumor with favorable histology. Post-treatment yearly follow-up for 5 years recorded a disease-free, normally thriving child.
Fulltext Clinical and genetic risk factors for new-onset diabetes mellitus after transplantation (NODAT) in major transplant centres in Malaysia

Guad RM, Taylor-Robinson AW, Wu YS, Gan SH, Zaharan NL, Basu RC, et al.

BMC Nephrol, 2020 09 07;21(1):388.
PMID: 32894076 DOI: 10.1186/s12882-020-02052-9

BACKGROUND: New-onset diabetes after transplantation (NODAT) is associated with reduced patient and graft survival. This study examined the clinical and selected genetic factors associated with NODAT among renal-transplanted Malaysian patients.
METHODS: This study included 168 non-diabetic patients (58% males, 69% of Chinese ethnicity) who received renal transplantation between 1st January 1994 to 31st December 2014, and were followed up in two major renal transplant centres in Malaysia. Fasting blood glucose levels were used to diagnose NODAT in patients who received renal transplantation within 1 year. Two single nucleotide polymorphisms (SNPs), namely; rs1494558 (interleukin-7 receptor, IL-7R) and rs2232365 (mannose-binding leptin-2, MBL2) were selected and genotyped using Sequenom MassArray platform. Cox proportional hazard regression analyses were used to examine the risk of developing NODAT according to the different demographics and clinical covariates, utilizing four time-points (one-month, three-months, six-months, one-year) post-transplant.
RESULTS: Seventeen per cent of patients (n = 29, 55% males, 69% Chinese) were found to have developed NODAT within one-year of renal transplantation based on their fasting blood glucose levels. NODAT patients had renal transplantation at an older age compared to non-NODAT (39.3 ± 13.4 vs 33.9 ± 11.8 years, p = 0.03). In multivariate analysis, renal-transplanted patients who received a higher daily dose of cyclosporine (mg) were associated with increased risk of NODAT (Hazard ratio (HR) =1.01 per mg increase in dose, 95% confidence interval (CI) 1.00-1.01, p = 0.002). Other demographic (gender, ethnicities, age at transplant) and clinical factors (primary kidney disease, type of donor, place of transplant, type of calcineurin inhibitors, duration of dialysis pre-transplant, BMI, creatinine levels, and daily doses of tacrolimus and prednisolone) were not found to be significantly associated with risk of NODAT. GA genotype of rs1494558 (HR = 3.15 95% CI 1.26, 7.86) and AG genotype of rs2232365 (HR = 2.57 95% CI 1.07, 6.18) were associated with increased risk of NODAT as compared to AA genotypes.
CONCLUSION: The daily dose of cyclosporine and SNPs of IL-7R (rs1494558) and MBL2 (rs2232365) genes are significantly associated with the development of NODAT in the Malaysian renal transplant population.