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Fulltext Sharing Information on COVID-19: the ethical challenges in the Malaysian setting

Yusof ANM, Muuti MZ, Ariffin LA, Tan MKM

Asian Bioeth Rev, 2020 Sep;12(3):349-361.
PMID: 32837556 DOI: 10.1007/s41649-020-00132-4

The COVID-19 pandemic has raised challenges in dealing with information sharing by the public and the authorities. There are two categories of information sharing on social media that are believed to be potentially problematic and unethical: the sharing of personal information of patients and the sharing of fake news or false information. We present a discussion on how the response to the COVID-19 pandemic in Malaysia can be ethically handled in terms of information sharing. It is recommended that the public should cultivate the basic skills to evaluate information and determine its validity. On the other hand, the authorities should refrain from placing the blame on patients to avoid them from being stigmatized. It is crucial that all parties are aware of their ethical duty to ensure only ethical and valid information gets shared on social media.
A Review of Delayed Facial Nerve Paresis as Complication Following Total Endoscopic Ear Surgery

Kamalden TMIT, Yusof ANM, Misron K

J Int Adv Otol, 2021 Nov;17(6):570-573.
PMID: 35177397 DOI: 10.5152/iao.2021.21189

The aim of this study is to evaluate the incidence of delayed facial nerve paresis after total endoscopic ear surgery. This review also aims to describe the possible contributing factors and its management. This is a retrospective review of all patients who had undergone total endoscopic ear surgery for all otologic cases that required endoscopic intervention in a single otologic center from 2014 up to 2020. The delayed facial nerve paresis is defined as deterioration of facial nerve function 72 hours after total endoscopic ear surgery. A total of 56 patients were included in the study. Delayed facial nerve paresis following total endoscopic ear surgery was observed in 2 patients (3.4%). Facial weakness sets in on day 6 post operation and another one developed at day 16 after the surgery. Both patients were investigated and only one of them showed a higher titer of Varicella zoster virus antibody while another patient showed no raise of titer. Thus, explanation of postoperative edema or mechanical compression is discussed. The incidence of delayed facial nerve paresis following total endoscopic ear surgery is rare. It can occur probably several days after surgery up to 3 weeks. Our 2 cases revealed that virus reactivation may not be the only factor for delayed facial nerve palsy after surgery. The overall prognosis for incomplete delayed facial nerve paresis is very good as both patients recovered well few days after treatment with steroids.
Factors affecting adherence to behaviours appropriate for the prevention of pressure injuries in people with spinal cord injury from Malaysia: a qualitative study

Mohamad Hashim N, Yusof ANM, Engkasan JP, Hasnan N

Spinal Cord, 2021 Jul;59(7):777-786.
PMID: 33230272 DOI: 10.1038/s41393-020-00586-1

STUDY DESIGN: Focus group qualitative study.
OBJECTIVES: To explore factors affecting adherence to behaviours appropriate for the prevention of pressure injuries (PIs) in people with spinal cord injury (SCI) in Malaysia.
SETTING: University Hospital, Malaysia METHODS: Four sets of focus group interviews were conducted, each with 5-10 participants, totalling 30 people with SCI. A trained interviewer used structured interviews designed to explore participants' experiences of complying with recommended behaviours for the prevention of PIs. All interviews were digitally recorded, transcribed, and analysed utilising thematic analysis.
RESULTS: The factors that affected participants' adherence are classified into four main themes: (a) educational aspects, (b) internal drive, (c) social and environmental factors, and (d) post-SCI physiological changes.
CONCLUSIONS: This qualitative study provides initial exploratory evidence regarding the thoughts, experience, and opinions pertaining to PI preventive behaviours within the Malaysian SCI population. The emerging themes contribute to an in-depth understanding of the competency of the Malaysian healthcare system in PI prevention, personal and societal factors influenced by the socio-demographic backgrounds, and disease-related factors that influence the adherence to such preventive interventions.
Prevalence of Hearing Loss among Very Low Birth Weight (VLBW) Babies in Two Tertiary Hospitals in Malaysia

Abdullah A, Wilfred R, Yusof ANM, Hashim WFW

Int Tinnitus J, 2023 Dec 04;27(1):16-26.
PMID: 38050880 DOI: 10.5935/0946-5448.20230004

OBJECTIVE: This study aimed to evaluate hearing loss among very low birth weight babies in two hospitals in Malaysia.
MATERIAL AND METHODS: A total of 380 babies from Hospital Canselor Tuanku Muhriz (HCTM), Kuala Lumpur and Sarawak General Hospital (SGH) were recruited in this retrospective study. All babies with birthweight less than 1500grams nursed in the Neonatal Intensive Care Unit (NICU) between January 2014 till December 2019 was included in the study. Data was analysed on demography, interval taken for hearing intervention and defaulter rate. The data of patient parameters between both hospitals were analysed and association between various factors were evaluated.
RESULTS: A total 187 Very Low Birth Weight (VLBW) Kuala Lumpur babies and 193 VLBW Sarawak babies met the inclusion and exclusion criteria, among which 10.1% and 10.9% had SNHL in Kuala Lumpur and Sarawak respectively. CHL was reported among 8.6% Kuala Lumpur and 14% of Sarawak babies. When studied on the different types and degrees of hearing loss, 2.6% of Kuala Lumpur babies born less than 28 Weeks Gestation Age (WGA) had moderate SNHL and 2.0% of Sarawak babies had profound SNHL. In this study only gestational age (week) (p=0.003) and dysmorphism (p<0.001) were statistically significant to be associated with hearing loss.
CONCLUSION: The prevalence of hearing loss among VLBW babies in Kuala Lumpur was 20.3% and 24.8% in Sarawak. Gestational age (p=0.044) and presence of dysmorphism (p<0.001) were found to have statistically significant association with prevalence of hearing loss. The defaulter rate at Kuala Lumpur was 52.6% and 42.3% in Sarawak.
Fulltext Temporal Bone Chondroblastoma: a Rare Entity

Yusof ANM, Thong HK, Kamalden TMIT

Med Arch, 2020 Aug;74(4):312-314.
PMID: 33041452 DOI: 10.5455/medarh.2020.74.312-314

INTRODUCTION: Chondroblastoma is an uncommon benign, locally destructive tumor that usually arises from epiphyses of the long bones. Temporal bone chondroblastoma is an extremely rare occurrence. Chondroblastoma arise from immature cartilage cells and it may display certain malignant features by invading surrounding structures and metastasizing to adjacent sites.
AIM: To present a case of extradural temporal bone chondroblastoma and discuss the clinical presentation, radiographic findings, histology and particularly the surgical management of the case.
CASE REPORT: We report a case of a 31-year-old man who presented with a painless left temporal swelling and left sided hearing loss for four months. Computed tomography (CT) scan revealed an aggressive mass involving the left preauricular region with temporal mastoid bone erosion. Magnetic resonance imaging (MRI) showed an extra-axial left temporal mastoid mass pushing the left temporal lobe superiorly. The patient underwent complete excision of the temporal bone tumor. The final histopathological diagnosis was in keeping with chondroblastoma.
CONCLUSION: Temporal bone chondroblastoma is rare but an aggressive condition. Complete tumor resection via an appropriate approach that enables adequate exposure will lead to a favorable outcome.
Fulltext A Case of Linear Scleroderma in a Young Child: A Diagnosis Easily Missed in Primary Care

Bin Ahmad MZ, Mat Nasir N, Md Yasin M, Yusof ANM, Bakrin IH, Lim SC

Am J Case Rep, 2023 May 19;24:e940148.
PMID: 37202915 DOI: 10.12659/AJCR.940148

BACKGROUND This case illustrates the challenges in diagnosing linear scleroderma (LS) in a child who presented to a primary care setting. Diagnosis of LS is easily missed due to the lack of prominent symptoms, subtle visible skin changes, and under-recognition of this condition. CASE REPORT A 7-year-old boy presented with a linear, painless, non-itchy rash at the center of his forehead, which has been present for 6 months. The rash extends vertically from the hairline to the bridge of the nose. The color gradually evolved from reddish to purplish-grey and shiny within 3 months. He had underlying eczema, allergic rhinitis, and allergic conjunctivitis since birth. His condition remained unrecognized despite consultations with various medical specialties, including family medicine specialist, ophthalmologist, otorhinolaryngologist, and a general pediatrician. Six months after the onset of his lesion, he was subsequently referred to a pediatric dermatologist and pediatric rheumatologist, who made the diagnosis of LS. Laboratory investigations for autoimmune disease showed that negative antinuclear antibodies (ANA) and inflammatory markers, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), were normal. Skin biopsy provided a tissue confirmation of the diagnosis. MRI of the lesion showed no extension into the underlying muscle or bone erosions. The patient was initially treated with intravenous (IV) methylprednisolone for 3 days, followed by oral methotrexate weekly and prednisolone. The lesion improved after 1 month of treatment, and after 15 months it was less pigmented and less noticeable. CONCLUSIONS LS is the commonest form of localized scleroderma in children. LS on the forehead can erode into the underlying tissues and is sometimes associated with extensive hemifacial atrophy. Treatment should be instituted early to prevent late irreversible fibrotic sequelae. This report aims to highlight the importance of early diagnosis and treatment of an uncommon but potentially disfiguring condition.
Honouring Wishes of Patients: An Islamic View on the Implementation of the Advance Medical Directive in Malaysia

Malek MM, Saifuddeen SM, Abdul Rahman NN, Yusof ANM, Abdul Majid WR

Malays J Med Sci, 2021 Apr;28(2):28-38.
PMID: 33958958 DOI: 10.21315/mjms2021.28.2.3

An Advance Medical Directive (AMD) is a document in which competent patients express their wishes regarding their preferred choice of future medical plans in the event they become incompetent. AMD is important in relation to the patient's right to refuse treatment. However, they must also consider cultural and religious values of different communities. In Islam, there are several concerns that need to be addressed, namely the validity of the AMD according to Islamic jurisprudence and patients' right to end-of-life decision-making. To address these concerns, this article refers to multiple sources of Islamic jurisprudence, such as the Quran, the tradition of Prophet Muhammad and the works of Islamic scholars related to this topic. Based on the findings, Islam does not forbid the use of AMD as a method to honour patients' wishes in their end-of-life care. Islamic jurisprudence emphasises on the importance of seeking patients' consent before carrying out any medical procedures. However, several conditions need to be given due attention, such as: i) a patient's cognitive capacity during the process of drawing up an AMD; ii) the professional views of medical experts; iii) the involvement of family members in end-of-life care and iv) the limitations of a patient's decision-making in creating an AMD.