Displaying publications 1 - 20 of 5012 in total

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  1. Sultan S, Irfan SM, Kaker J, Hasan M
    Med J Malaysia, 2016 04;71(2):53-6.
    PMID: 27326941
    BACKGROUND: The effect of Helicobacter-pylori eradication therapy on the platelet counts in patients with immune thrombocytopenia is still debatable. The aim of this study was to assess the response rates of standard triple eradication therapy in secondary immune thrombocytopenia with Helicobacter pylori infection.

    METHODS: From January 2012 to December 2013, 197 patients were diagnosed to have immune thrombocytopenia, out of which 22(11.1%) patients infected with Helicobacter- Pylorus were enrolled in this study. Helicobacter-Pylori infection was documented by Helicobacter-pylori stool antigen enzyme immunoassay method. All positive patients were put on triple eradication therapy. The responses rates to treatment were defined as per International Working Group on ITP.

    RESULTS: Mean age of patients was 43.18±12.5 years. There were 10(45.5%) males and 12 (54.5%) females. Of the 22 patients, 7(31.8%) exhibited a complete response (CR) to Hpylori eradication therapy; 10(45.4%) attained a response; and 5(22.7%) had no response. Mean base line platelet counts were 53.36±24.5x109/l, while platelet counts at 4 week following eradication was 80.86±51.0x109/l (P=0.003). The predictive factor of response following eradication therapy was baseline platelet counts. Virtually all responders had baseline platelet counts >30x109/l and all non-responders had <30x109/l of platelet counts.

    CONCLUSIONS: Though the prevalence of H-pylori is low, this study confirmed the efficacy of eradication in increasing the platelet counts in H-pylori positive patients with ITP. It is an important measure in short time, safe and very cost effective to achieve platelets increment. We endorse the routine detection and eradication treatment of H-pylori infective ITP patients.

  2. Yusof NM, Fadzli AS, Azman WS, Azril MA
    Med J Malaysia, 2016 04;71(2):47-52.
    PMID: 27326940 MyJurnal
    INTRODUCTION: The understanding of the skin's vascular anatomy has improved in the last decade. It has lead to technique modification such as the staged procedure in performing sural flaps and improvement in the flap survival rate. The aim of this study was to evaluate the acute vascular complications (flap necrosis or congestion) of 29 patients who underwent distal base sural flap for coverage of wound around the ankle.

    METHODS: Twenty-four males and five females with a mean age of 37.1 years old underwent sural flap surgery to cover wounds at around the ankle. There were 12 cases of open fracture, five infected fractures, four spoke injuries, four degloving injuries and four diabetic foot ulcers. Twentythree cases were done as a single stage procedure while six as a two-stage procedure. The flaps were tunnelled under the skin in three cases.

    RESULTS: Twenty one flaps healed uneventfully, seven acute vascular complications occur in a single stage group: five developed partial necrosis, one had congestion with epidermolysis, and one had complete flap necrosis. Complications were treated by dressing or skin grafting and only one required a repeat flap surgery.

    CONCLUSIONS: Acute vascular complications may be minimised when sural flap is done in stages for elderly, diabetic, smokers and/or patients with large wound around the ankle. Even if the flap appears necrotic, the underlying structure may still be covered as the fasciosubcutaneous layer of the flap may still survive.

  3. Mohamed NA, Ramli S, Amin NN, Sulaiman WS, Isahak I, Jamaluddin TZ, et al.
    Med J Malaysia, 2016 04;71(2):62-5.
    PMID: 27326943 MyJurnal
    INTRODUCTION: Nasal colonisation of S. aureus in healthy children was 18% to 30%. One to three percent of them were colonised by Methicillin-resistant Staphlycoccus aureus (MRSA). Although MRSA infection has become increasingly reported, population-based S. aureus and MRSA colonisation estimates are lacking. The main objective of this study was to determine the prevalence of S. aureus carriage among children.

    METHODS: Nasal samples for S. aureus culture were obtained from 250 children from three kindergartens in the Klang Valley, after consent was obtained from the children and their parents. Swabs were transported in Stuart medium, and inoculated on mannitol-salt agar within four hours of collection. Identification and disk diffusion test were done according to guidelines. Polymerase chain reaction was done on MRSA isolates for the presence of mecA and lukS/FPV genes.

    RESULTS: Overall prevalence of S. aureus and MRSA carriage were 19.2% (48/250) and 1.6% (4/250) respectively. mecA gene was present in all isolates, 50% isolates carried Panton-Valentine leucocidin (PVL) gene. Sccmec type I was found in 2 isolates and the remaining isolates has Sccmec type V.

    CONCLUSION: The prevalence of S. aureus and MRSA carriage were similar to other studies. However, risk of contracting severe infection might be higher due to presence of PVL gene in half of the MRSA isolates.
  4. Tang CT, Wilkerson PM, Soon Y
    Med J Malaysia, 2016 04;71(2):57-61.
    PMID: 27326942
    INTRODUCTION: Biomedical research has traditionally been the domain of developed countries. We aim to study the effects of the increased focus on biomedical and medical research on level 1-4 publications in several industrialised and newly industrialised countries endowed with petroleum and gas resources.

    METHODS: We identified all level 1-4 publications from 01/01/1994 to 31/12/2013 via PubMed using advanced options. The population and GDP (current US$) data from 1994-2013 were obtained through data provided by the World Bank and the raw data was normalised based on these two indicators.

    RESULTS: From 1994-2013, Saudi Arabia and Malaysia were responsible for the highest absolute number of level 1 to 4 biomedical and medical research publications with 2551 and 1951 publications respectively. When normalised to population, Kuwait and Qatar had the highest publication rates, with 7.84 and 3.99 publications per 100,000 inhabitants respectively in a five yearly average. Kuwait produced the largest number of publications per billion (current US$) of GDP, at 2.92 publications, followed by Malaysia at 2.82 publications in a five yearly average.

    CONCLUSION: The population size of a country as well as GDP can influence the number of level 1-4 publications in some countries. More importantly, effective government policy which stimulates research as well as a culture which actively promotes research as shown by Malaysia have proven to have a larger influence on the amount of level 1-4 biomedical and medical publications.
  5. Tan CJ, Thang SP, Lam WW
    Med J Malaysia, 2016 04;71(2):69-71.
    PMID: 27326945
    Peritoneal radionuclide scan is an established imaging modality for evaluating peritoneopleural communications. In this case report, unusual mediastinal lymph node radiotracer uptake is seen in a patient with portal hypertension on peritoneal scintigraphy. This was suspected to be due to marked lymphatic enlargement from longstanding portal hypertension since childhood, permitting passage of the large Tc-99m MAA particle. The nodes were morphologically benign on CT. Mediastinal lymph node uptake on peritoneal scintigraphy is rare but should not raise undue clinical concern, particularly in a patient with chronic portal hypertension. Anatomic correlation with SPECT-CT can provide reassurance.
  6. Sam JI, Chan YF, Vythilingam I, Wan Sulaiman WY
    Med J Malaysia, 2016 04;71(2):66-8.
    PMID: 27326944 MyJurnal
    Zika virus (ZIKV) has re-emerged to cause explosive epidemics in the Pacific and Latin America, and appears to be associated with severe neurological complications including microcephaly in babies. ZIKV is transmitted to humans by Aedes mosquitoes, principally Ae. aegypti, and there is historical evidence of ZIKV circulation in Southeast Asia. It is therefore clear that Malaysia is at risk of similar outbreaks. Local and international guidelines are available for surveillance, diagnostics, and management of exposed and infected individuals. ZIKV is the latest arbovirus to have spread globally beyond its initial restricted niche, and is unlikely to be the last. Innovative new methods for surveillance and control of vectors are needed to target mosquito-borne diseases as a whole.
  7. Thevi T, Sahoo S
    Med J Malaysia, 2016 Apr;71(2):45-6.
    PMID: 27326939
    PURPOSE: To analyse the visual outcomes of cases with posterior capsule rupture (PCR) compared to those without PCR following phacoemulsification. The occurrence of posterior capsule rupture during phacoemulsification surgery for cataract can have serious implications in the visual recovery. However, recognition of PCR and proper management can yield a successful visual outcome. This study analysed the visual outcomes of cases with PCR compared to those without PCR.

    METHODS: This is a case-control study. All patients who underwent cataract surgery from 2011 to 2012 in Hospital Melaka were traced from the National Eye Database (NED) of Malaysia. The visual outcomes were classified as good, borderline and poor as per WHO guidelines. The data was analysed with SPSS version 12 IBM.

    RESULTS: Out of 80.4% (2519) of eyes that had undergone phacoemulsification (PHACO) type of surgery, 3.06% (77 cases) had posterior capsule rupture complication. There was no significant difference in the visual outcome of borderline between cases with PCR and cases without PCR (Odds Ratio (OR) 0.989; 95% Confidence Interval (CI) 0.382- 2.560). However, cases with PCR were significantly less likely to have good vision compared to those without PCR (OR 0.335; 95% CI 0.157-0.714).

    CONCLUSION: The study reveals that a significant number of patients without PCR had good vision, whereas those with PCR did not get good vision. We would like to suggest meticulous care during phacoemulsification surgery to avoid PCR in order to obtain good visual outcomes.
  8. Sherrini BA, Chong TT
    Med J Malaysia, 2014 Aug;69 Suppl A:103-11.
    PMID: 25417957
    Between September 1998 to May 1999, Malaysia and Singapore were hit by an outbreak of fatal encephalitis caused by a novel virus from the paramyxovirus family. This virus was subsequently named as Nipah virus, after the Sungei Nipah village in Negeri Sembilan, where the virus was first isolated. The means of transmission was thought to be from bats-topigs and subsequently pigs-to-human. Since 2001, almost yearly outbreak of Nipah encephalitis has been reported from Bangladesh and West Bengal, India. These outbreaks were characterized by direct bats-to-human, and human-to-human spread of infection. Nipah virus shares many similar characteristics to Hendra virus, first isolated in an outbreak of respiratory illness involving horses in Australia in 1994. Because of their homology, a new genus called Henipavirus (Hendra + Nipah) was introduced. Henipavirus infection is a human disease manifesting most often as acute encephalitis (which may be relapsing or late-onset) or pneumonia, with a high mortality rate. Pteropus bats act as reservoir for the virus, which subsequently lead to human spread. Transmission may be from consumption of food contaminated by bats secretion, contact with infected animals, or human-to-human spread. With wide geographical distribution of Pteropus bats, Henipavirus infection has become an important emerging human infection with worldwide implication.
  9. Swarna Nantha Y
    Med J Malaysia, 2014 Aug;69 Suppl A:88-102.
    PMID: 25417956 MyJurnal
    One hundred seventy four articles related to tuberculosis were found in a search through a database dedicated to indexing all original data relevant to medicine published in Malaysia between the years 2000-2013. One hundred fifty three articles were selected and reviewed on the basis of clinical relevance and future research implications. Topics related to epidemiology, clinical presentation, detection methods and treatment were well researched. However, limited information was available on screening and behavioural interventions. The younger population were more vulnerable to tuberculosis infection and had higher prevalence of risk factors that reactivate tuberculosis infection. Screening of tuberculosis was conducted primarily on healthcare workers, tuberculosis contacts, prisoners and foreign workers. Data on the clinical presentation of pulmonary and extrapulmonary tuberculosis was comprehensive. There was a general focus on related risk factors such as HIV and diabetes mellitus. A great degree of information was available on the treatment and various detection methods to identify tuberculosis. The efficacy and the practicality of investigative methods was analysed in this review. In conclusion, the direction of research should be aimed at novel preventive and control measures of tuberculosis. There should be emphasis on the screening of high risk groups (other than HIV) within the population namely diabetic patients, smokers and immunosuppressed individuals. The design of health policies should be guided by information gathered from research evaluation of communitybased behavioural interventions.
  10. William T, Menon J
    Med J Malaysia, 2014 Aug;69 Suppl A:82-7.
    PMID: 25417955 MyJurnal
    One hundred and thirteen articles related to Malaria were found in a search through a database dedicated to indexing all original data relevant to medicine published in Malaysia between the years 2000-2013. Thirty eight articles were selected and reviewed on the basis of clinical relevance and future research implications. The epidemiology of malaria has undergone a significant change over the last decade with P. knowlesi, formerly a relatively unknown simian parasite rapidly becoming the most predominant malaria species to infect humans in Malaysia. The epidemiology, clinical features, diagnostic methods and treatment for P. knowlesi infection are described in these studies. In Malaysia, imported malaria from foreigners also poses a challenge. In view of these changes, new strategies on malaria control need to be devised and implemented, and treatment regimens need to be redefined to help Malaysia achieve the goal of malaria elimination by the year 2020.
  11. Koh KC
    Med J Malaysia, 2014 Aug;69 Suppl A:68-81.
    PMID: 25417954 MyJurnal
    Two hundred fifty seven articles related to HIV/AIDS were found in a search through a database dedicated to indexing all original data relevant to medicine published in Malaysia between the years 2000-2013. One hundred seventy one articles were selected and reviewed on the basis of clinical relevance and future research implications. This review of literature has been divided into six sections, namely, epidemiology, risk behaviour, clinical features and opportunistic infections, management, diagnosis and discussion. Wherever possible, the reviewed articles have been presented in a chronological order to provide a historical perspective to the reader as many of the results of earlier publications, which are common knowledge now, were relatively unknown then. Since the early days of the HIV epidemic in Malaysia, there have been rapid advances in the understanding and the management of the epidemic in Malaysia based on the insights derived from the results of these research. These insights are invaluable tools for policy makers, advocators, healthcare providers, researchers and everyone and anyone who are involved in the care of individuals with HIV/AIDS. Attempts have been made to identify gaps in certain research areas with the hope of providing directions for future research in HIV/AIDS in Malaysia.
  12. Sthaneshwar P, Vethakkan SR, Wong CW
    Med J Malaysia, 2014 Aug;69(4):175-7.
    PMID: 25500845 MyJurnal
    INTRODUCTION: Glycohemoglobin (HbA1c) most accurately reflects the previous two to three months of glycaemic control. HbA1c should be measured regularly in all patients with diabetes, and values should be maintained below 7% to prevent the risk of chronic complications. Apart from the genetic variants of haemoglobins many other conditions also known to affect HbA1c measurements. In this study we evaluated the conditions that cause low HbA1c results.

    METHODS AND MATERIALS: The data was collected retrospectively HbA1c was measured in our laboratory by Biorad Variant II turbo 2.0. The method is based on chromatographic separation of HbA1c on a cation exchange cartridge. This method has been certified by National Glycohemoglobin Standardization Programme (NGSP). 58437 requests were received in a period of one year (January to December 2011). Medical records were reviewed to identify the conditions that might be associated with these low values.

    RESULTS: Among 58437 samples analysed, 53 patients had HbA1c levels < 4.0%. Fourteen patients had haemoglobinopathy. In 34 patients without Hb variants had conditions such as chronic liver disease, chronic kidney disease, haemolytic anaemia, pregnancy, and anaemia of chronic disease. Five non-pregnant individuals who were screened for diabetes mellitus had HbA1c levels < 4%.

    CONCLUSION: Our study underscores the importance of that both laboratories and the physicians should be aware of the factors that can influence the HbA1c results. The haematological status should be taken into consideration for proper interpretation of HbA1c results.
  13. Chua SK, Kilung A, Ong TK, Fong AY, Yew KL, Khiew NZ, et al.
    Med J Malaysia, 2014 Aug;69(4):166-74.
    PMID: 25500844 MyJurnal
    INTRODUCTION: Carotid intima media thickness (CIMT) being a cost effective and easily performed technique is useful in the detection of subclinical atherosclerosis and has been shown to be a prognosticator of cardiovascular events. The primary objective of this study was to obtain the distribution of CIMT measurements, highly sensitive C reactive protein (hs-CRP) and assessing health awareness and attitudes of the Malaysian population at cardiovascular disease (CVD) risk and not receiving lipid lowering agents. Secondarily the study sought to assess the significance of the relationship between these measurements against various patient characteristics.

    METHODS: Measurements of CIMT are obtained by ultrasonography of 12 sites within the common carotid artery was recorded for 123 subjects from a single centre tertiary hospital of Malaysia who had two or more CVD risk factors but were not receiving lipid lowering therapy. CVD risk factors and lipid and glucose profiles were analyzed with respect to distribution of CIMT and high-sensitivity Creactive protein (hs-CRP) values.

    RESULTS: The mean-max CIMT was 0.916±0.129mm (minimum 0.630mm, maximum 1.28mm) and the mean-mean CIMT was 0.743±0.110mm (minimum 0.482mm, maximum 1.050mm) and mean hs-CRP was 0.191mg/dL (minimum 0.030mg/dL, maximum 5.440mg/dL). Multivariate analyses confirmed a significant association between increasing CIMT and increasing age, total and low density lipoprotein cholesterol while log-transformed hs-CRP levels showed significant association with increasing body mass index, waist circumference, high blood glucose and triglyceride levels. Our patients had good health awareness on CVD.

    CONCLUSION: Newly defined CIMT measurements and hs-CRP levels may be useful adjunctive tools to screen for atherosclerosis in the Malaysian population. It may help in refining risk stratification on top of traditional clinical assessment.
  14. Jee SL, Lim KF, Krishnan R
    Med J Malaysia, 2014 Aug;69(4):191-2.
    PMID: 25500850 MyJurnal
    Hemobilia is a rare but potentially lethal condition. The commonest cause of hemobilia is trauma, accounting up to 85% of all cases. Hemobilia caused by gallstones is very rare. Most of the cases of hemobilia are either managed conservatively or treated by embolization. Surgery is indicated only when there is an associated surgical condition or when embolization fails. We report a case of a 72-year-old patient with massive hemobilia caused by gallstone erosion to the adjacent artery, diagnosed intraoperatively. The complication was successfully managed by cholecystectomy and repair of the bleeding vessel. This case highlights the importance that hemobilia should be suspected in patients presenting with upper gastrointestinal bleeding. Although rare, massive hemobilia can be life threatening, leading to significant morbidity and mortality. Therefore, a high index of suspicion and timely intervention are important.
  15. Wong AC, Khoo CS, Ee YS, Sidhu JK, Chan LG
    Med J Malaysia, 2014 Aug;69(4):189-90.
    PMID: 25500849 MyJurnal
    Tracheal agenesis is a rare congenital airway anomaly which presents as an airway emergency at birth. We report a case of late premature Chinese infant with tracheal agenesis type II (by Floyd's classification) who presented with severe respiratory distress at birth. He had multiple failed attempts at intubations with accidental oesophageal intubation and ventilation. Tracheal agenesis with tracheo-oesophageal fistula was suspected from an emergency optical laryngoesophagoscopy done. The infant was subsequently stabilized on oesophageal ventilation. The diagnosis was confirmed on CT scan and parents were counseled regarding the poor outcome and decided for withdrawal at day 7 of life.
  16. Vijendren A, Ladha N, Hilger AW
    Med J Malaysia, 2014 Aug;69(4):187-8.
    PMID: 25500848
    Spontaneous thyroid haemorrhages are rare. There are reported cases occurring in thyroid nodules and cysts but none in thyroid malignancies. We describe a 48 year old who presented to the on-call ENT team with a rapidly progressing neck swelling that was interfering with his airway. After resuscitation, the patient underwent a right lobectomy to stop the bleeding. Histology showed a thyroid follicular carcinoma. As per the regional multidisciplinary team discussion, he underwent a completion thyroidectomy followed by radioactive iodine treatment. We conclude that spontaneous haemorrhages of the thyroid gland can occur in malignancies and stress the importance of early histological diagnosis.
  17. Palaniappan S, Aizan H
    Med J Malaysia, 2014 Aug;69(4):184-6.
    PMID: 25500847 MyJurnal
    Tuberculosis, an ancient disease continues to be a health care burden in Malaysia in the 21st century. Extrapulmonary tuberculosis is a less common presentation of tuberculosis and in particular peripancreatic tuberculous lymphadenitis is rarely seen. We report a case of a young immunocompetent boy presenting with a two month history of non productive chronic cough associated with loss of appetite and loss of weight. Investigations including CT Scan and Endoscopic ultrasound revealed multiple mediastinal lymphadenopathy and peripancreatic lymphadenopathy with central caseation necrosis. Histology of cervical lymph node was suggestive of tuberculosis and mycobacterium PCR was positive. The patient was subsequently treated with antituberculous therapy and had marked clinical improvement of his symptoms. This case outlines a rare presentation of a common disease and the application of newer investigative tools in making the diagnosis.
  18. Aina Mariana AM, Yap SH
    Med J Malaysia, 2014 Aug;69(4):178-83.
    PMID: 25500846 MyJurnal
    The aim of this study was to evaluate the management and clinical outcome of transfusion-dependent thalassaemia children receiving care in the Paediatric Ambulatory Care Centre, Hospital Tuanku Ja'afar Seremban in comparison to The Malaysian Clinical Practice Guidelines. The demography, management and clinical outcome of the patients were documented using a checklist. Information on compliance to chelation agents was obtained through interview. There were twenty-six patients recruited in this study out of thirty seven patients registered in the centre. This study showed that more effort and vigilance should be given to ensure that the management of these patients adheres to the guidelines and clinical outcome of these patients monitored closely.

    Study site: Paediatric Ambulatory Care Centre, Hospital Tunku Ja'afar, Seremban.
  19. Wong JL, Tie ST, Lee J, Kannan SK, Rashid Ali MR, Ibrahim A, et al.
    Med J Malaysia, 2014 Aug;69(4):195-6.
    PMID: 25500852 MyJurnal
    Recurrent respiratory papillomatosis (RRP) is a benign disease caused by the human papilloma virus (HPV), characterized by the formation of recurrent, epithelial neoplastic lesions in the airways. While benign, they can cause significant airway obstruction in some cases. Difficulties in treatment arise from the recurrent nature of the lesions despite repeated procedures. Other known procedures that result in deep tissue damage also cause unacceptable collateral damage to the underlying airway mucosa. We describe a case of recurrent papillomatosis that was successfully treated with argon plasma coagulation ( APC) when laser and electrocautery ablation had failed in the past. After the papillomatasis was treated with APC, there is no recurrence on repeat scope at 4 months and 9 months after the initial procedure. The procedure was done as a day case and there is no complication from the procedure. The property of the APC that allows it to cause only superficial thermal damage to the tissue makes it a suitable adjunct therapy to the treatment of papillomas, which are usually superficial lesions.
  20. Ariffin H, Geikowski A, Chin TF, Chau D, Arshad A, Abu Bakar K, et al.
    Med J Malaysia, 2014 Aug;69(4):193-4.
    PMID: 25500851 MyJurnal
    We report a case of Griscelli Syndrome (GS). Our patient initially presented with a diagnosis of haemophagocytic lymphistiocytosis (HLH). Subsequent microscopic analysis of the patient's hair follicle revealed abnormal distribution of melanosomes in the shaft, which is a hallmark for GS. Analysis of RAB27A gene in this patient revealed a homozygous mutation in exon 6, c.550C>T, p.R184X . This nonsense mutation causes premature truncation of the protein resulting in a dysfunctional RAB27A. Recognition of GS allows appropriate institution of therapy namely chemotherapy for HLH and curative haemotopoeitic stem cell transplantation.
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