PRESENTATION OF CASE: We report a 63-year-old lady with incidental findings of adrenal tumour on computed tomography (CT) scan during a routine medical check-up. She underwent tumour resection in view of a large tumour of 7 cm in size.
DISCUSSION: CT scan is sensitive to diagnose adrenal myelolipoma in view of its fat-laden property and useful to monitor the tumour progress. Even previously she opted for conservative management; the decision for surgery was made in view of enlarging tumour and risk of surrounding tissue compression.
CONCLUSION: With increased awareness, the detection rate of this tumour is improving, hence able to prevent the complications of a large tumour such as compression, bleeding and tumour necrosis.
Case presentation: We report a case 41 years old female presented with lesion on the scalp and sternal mass, increasing in size with itchiness and erythematous for 6 months duration. Further CECT scan of brain and neck shows features of malignant left frontal scalp lesion with poor plane with overlying skin and underlying skull bone and CECT of thorax shows a large, irregular heterogeneously enhancing mass with necrotic center noted at right hilar within superior segment of right lower lobe, encasing right middle and lower lobe bronchi. Wedge biopsy of scalp lesion showed an intradermal lesion extensively infiltrating by malignant gland accompanied by desmoplasia and the tumor cells are seen extending into the surgical margins suggestive of ductal eccrine carcinoma.Clinical Discussion:This case highlights the importance and challenges in achieving early diagnosis coupled with the scarcity of information on these leads to difficulty in managing this patient.
Conclusion: In managing Ductal Eccrine Carcinoma tumor, standard method of treatment for has not been established. However, wide surgical excision is the treatment of choice for localized lesions. Regarding prognosis, there is conflicting data published which we describe in this article.
Case presentation: We report a huge recurrent right lateral abdominal DFSP with local invasion in a 35-year-old lady. After wide local excision, the reconstruction was done by using pedicled anterolateral thigh fasciocutaneous flap and gluteal fasciocutaneous rotational flap.
Clinical discussion: The goal of reconstruction of the lateral abdominal wall is similar to that of the anterior abdominal wall, namely to provide a static repair that will not attenuate and form a bulge or hernia over time. Anchoring a mesh to stable fixation points is expected to ensure structural integrity in the LAW defect. However, we selected fascial inset from our flaps which did not lead to hernia formation or a bulge following a 7-month postoperative review. In terms of soft tissue coverage, the pedicled anterolateral thigh fasciocutaneous flap and gluteal fasciocutaneous rotational flap were used. The standard free flap will require more complexity of works, especially if the recipient vessels for microsurgical reconstruction are remotely situated or sometimes not even available.
Conclusion: Huge full-thickness LAW defect following an oncological resection can be reconstructed with combination of simpler locoregional flaps which yield good functional and aesthetic outcome.
OBJECTIVE: The purpose of this study was to assess the association between dietary pattern and H. pylori infection among patients aged 18 years and above that went for first esophagogastroduodenoscopy (OGDS) in 2021 at Queen Elizabeth Hospital (QEH), Kota Kinabalu.
METHODS: Dietary intake of positive H. pylori was compared with healthy subjects by using questionnaire adapted from Malaysian Adult Nutrition Survey (MANS) 2014. Using logistic regression models, we evaluated the association between dietary pattern and H. pylori infection risk.
FINDINGS: Our finding identified four dietary patterns, namely "high carbohydrate pattern", "high fiber pattern", "high fat/cholesterol pattern" and "high salt pattern". After adjustment for potential confounders, the highest quartile of "high salt pattern" showed greater odds of H. pylori infection (OR = 1.26; 95% Cl: 1.032-1.459; P = 0.045) than lowest quartile, while highest quartile of "high fiber pattern" demonstrated lower odd of the infection (OR = 0.69; 95% Cl: 0.537-0.829; P = 0.008) than those in lowest quartile. If compared with Recommended Nutrient Intake (RNI) 2017, positive H. pylori consumed high carbohydrates and sodium with insufficient fiber intake.
CONCLUSION: To conclude, "high fiber pattern" lowers the risk of H. pylori infection while "high salt pattern" increases the infection risk. Our study also highlighted the importance of nutrient intake within daily allowances.
CASE PRESENTATION: We report a case of a 40-year-old lady with primary infertility for six years with underlying polycystic ovary syndrome (PCOS) and BMI 45.7 whom was successfully conceived twice following bariatric surgery procedure in which reduction of 70% of her BMI prior to bariatric surgery lead to her spontaneous conception without fertility intervention and successful live birth.
CLINICAL DISCUSSION: Obese PCOS needs multidisciplinary approaches which include weight loss program such as dietary advice, exercise intervention as part of preliminary treatment prior to ovulation induction and counselling.
CONCLUSION: Bariatric surgery has been a mainstay treatment in patients with morbid obesity and those with BMI more than 35 associated with obesity related problems such as joint pain, hypertension or diabetes mellitus. Bariatric surgery such as laparoscopic sleeve gastrectomy should be considered more often in contrast to lifestyle modification for morbidly obese lady with PCOS and infertility prior to the use of standard ovulation induction regime for treating infertility.
OBJECTIVE: The purpose of this study was to determine the effect of work setting and demographic factors on nurses' caring behaviour, as well as the differences in nurses' caring behaviour based on demographic factors between nurses in public hospitals and nurses in public health services in Sabah, Malaysia.
METHODS: This research is a cross-sectional study using the survey method. Data were collected from 3,532 nurses (88.3% response rate) in public hospitals and public health services within Sabah, Malaysia. Data were analysed using two-way ANOVA.
RESULTS: The two-way ANOVA test revealed no significant impact of the work setting on CB, nor was there a notable interaction between the work setting and demographic factors influencing nurses' CB. However, demographic factors such as gender, age, education, economic status, position, and experience had a significant effect on CB.
CONCLUSION: The present research has provided convergent evidence on the effect of demographic factors on nurses caring behavior and the differences in caring behavior based on demographic factors among nurses in public hospitals and public health services in Sabah, Malaysia.