Med J Malaysia. 2016 Jun;71(3):154-5
Authors: Lau YW, Vikneswaran T, Tan TY, Tang IP
BACKGROUND: Angioleiomyoma of the nasal cavity is an extremely rare benign neoplasm. It usually occurs in the lower extremities. Up to date, only few cases of angioleiomyoma have been reported. First case of angioleiomyoma of nasal cavity was reported in 1966. We report a rare case of angioleiomyoma arising from the right maxillary sinus.
CASE REPORT: A 43-year-old lady presented with recurrent epistaxis and right nasal obstruction for two months duration. Clinical examination revealed a huge right nasal mass obstructing the right nasal cavity. The tumour was excised completely via endoscopic endonasal surgical approach. Histopathological examination confirmed the tumour is sinonasal angioleiomyoma. Postoperatively, she recovered well without any recurrence after a year of followup.
CONCLUSION: This tumour has an excellent prognosis and recurrence is extremely rare if excised completely.
PMID: 27495895 [PubMed - in process]
Gram-negative infection as an unusual cause of endocarditis in a hemodialysis patient.
Med J Malaysia. 2016 Jun;71(3):152-3
Authors: Balakrishnan S, Aamar A, Rhee S, Zakaria S, Khaliq W
Gram-negative endocarditis is rare and it has high mortality if there is a delay in diagnosis and treatment. Gram-negative organisms should be considered in the differential diagnosis of IE in hemodialysis patients. Central lineassociated bloodstream infections (CLABSIs) can be prevented by following sterile measures during catheter insertion and proper management of catheter site.
PMID: 27495894 [PubMed - in process]
Primary breast tuberculosis (TB) in a patient with known invasive breast carcinoma: A case report.
Med J Malaysia. 2016 Jun;71(3):149-51
Authors: Lee CH, Sharif SZ
Breast tuberculosis (TB) is rare even in endemic countries. Most of these cases occur as secondary TB due to a concurrent infection. Primary breast TB is diagnosed when it is the only site of disease without other foci of infection. The presentation of primary breast TB may often mimic carcinoma of the breast. While imaging is not specific, histopathology provides a definitive diagnosis. Here, we present a case of primary breast TB in a breast cancer patient and review the literature.
PMID: 27495893 [PubMed - in process]
Cardiac tamponade: a rare but preventable complication of central venous catheter in neonates.
Med J Malaysia. 2016 Jun;71(3):147-8
Authors: Atmawidjaja RW, Azri M, Ismail IH
Pericardial effusion with cardiac tamponade is a rare and life-threatening complication of peripherally inserted central catheter (PICC) in a neonate. We report a 33-week preterm neonate who had sudden clinical deterioration at day seven of total parenteral nutrition regime via PICC. Recognition of pericardial effusion with cardiac tamponade in neonates with a PICC requires a high index of suspicion and steps in prevention include proper catheter tip placement and continuous monitoring of line position and function.
PMID: 27495892 [PubMed - in process]
Polypoid endometriosis of post vaginal fornix: utility of MRI imaging of pelvis with diffusion weighted imaging for diagnosis.
Med J Malaysia. 2016 Jun;71(3):144-6
Authors: Tham WP, Busmanis I, Tan WC, Kwek JW
Polypoid endometriosis is an uncommon variant of endometriosis which can mimic malignancy due to its presentation as masses. We present a case of polypoid endometriosis which simulated cervical malignancy both on clinical examination and on computed tomography (CT) scanning and discuss how magnetic resonance (MR) imaging, in particular Diffusion Weighted Imaging (DWI), can help to distinguish this condition from true malignancy and avoid invasive surgery.
PMID: 27495891 [PubMed - in process]
Allergic reaction to stainless steel sternotomy wires requiring removal: A case report and literature review.
Med J Malaysia. 2016 Jun;71(3):142-3
Authors: Lopez J, Sachithanandan A, Leow M
Hypersensitivity to stainless steel sternal sutures are an uncommon occurrence. We present a case of such a patient who developed chronic tissue overgranulation over a sternotomy wound eight weeks post-operatively. Primary suspicion was infection, a more common complication however radiological and laboratory investigation showed otherwise. Conservative management provided limited ephemeral success. After ensuring adequate sternal bone healing, the sutures and granulation tissue were eventually surgically removed without complication and the reoperated wound healed well.
PMID: 27495890 [PubMed - in process]
Thoracic Aortic Aneurysm as A Cause of Ortner's Syndrome - A Case Series.
Med J Malaysia. 2016 Jun;71(3):139-41
Authors: Ismazizi Z, Zainal AA
Hoarseness due to left recurrent laryngeal nerve paralysis was first described in 1897 by Norbert Ortner. Various cardiopulmonary and thoracic arch aorta pathologies associated with left recurrent laryngeal nerve palsy have been described over the last 100 years and is also known as cardio-vocal syndrome. We report our experience with seven cases of Ortners syndrome due to thoracic aortic aneurysm with compression of the left recurrent laryngeal nerve and resultant hoarseness.
PMID: 27495889 [PubMed - in process]
Serotype prevalence of Streptococcus pneumoniae in Malaysia - the need for carriage studies.
Med J Malaysia. 2016 Jun;71(3):134-8
Authors: McNeil HC, Clarke SC
Pneumococcal disease, caused by the bacterium Streptococcus pneumoniae, is a major burden to global health. Although the World Health Organisation (WHO) strongly recommends the inclusion of pneumococcal conjugate vaccines in national immunisation programmes (NIP's) worldwide, this has not occurred in many countries in the WHO South East Asia and Western Pacific regions - particularly longstanding middle-income countries. It is widely accepted that carriage of S. pneumoniae is a precursor to developing any pneumococcal disease. The reduction in pneumococcal disease from vaccine serotypes (VT) following widespread implementation of the pneumococcal conjugate vaccine (PCV) is believed to be through the direct immunogenic protective effect of immunised individuals as well as indirectly through herd immunity diminishing the incidence of disease in nonimmunised individuals. In Malaysia, pneumococcal disease is not included in national surveillance programmes and although PCVs have been licensed, they have not been included in the NIP. Hence, the vaccine is only available privately and the majority of the population is not able to afford it. There is an urgent need to develop surveillance programmes in Malaysia to include pneumococcal serotype data from carriage and invasive disease so that it may help guide national vaccine policy prior to a decision being taken on the inclusion of PCVs in the NIP.
PMID: 27495888 [PubMed - in process]
Routine measurements of cord arterial blood lactate levels in infants delivering at term and prediction of neonatal outcome.
Med J Malaysia. 2016 Jun;71(3):131-3
Authors: Revathy Natesan S
OBJECTIVE: Our purpose was to evaluate the relationship between umbilical cord arterial blood lactate levels with acid base balance to the mode of delivery and short-term neonatal outcome in a large multiracial population delivering at term in University of Malaya Medical Centre.
MATERIALS AND METHODS: Two thousand two hundred and twelve patients of more than 37 weeks of gestation with singleton, liveborn infants with no major anomalies delivering between January 2013 to December 2013 were analysed. Lactate was measured by using portable Lactate analyzer that requires 5 μml of blood and provides the result within 1 minute. The deliveries took place at the Department of Obstetrics and Gynaecology, University Malaya Medical Centre, Malaysia where umbilical cord blood sampling and blood gas analysis is a part of the routine assessment of all newborn.
RESULTS: Gestational age ranged from 37 to 43 weeks (mean 39.05 weeks). The highest mean arterial cord lactate values were noted among babies delivered instrumentally (4.87 mmol/L). Infants who had a normal vaginal delivery had the second highest levels (3.36 mmol/L), followed by infants delivered by emergency caesarean section (3.30mmol/L). The lowest lactate values were noted in deliveries by elective caesarean section (3.0mmol/L). Cord arterial lactate levels were significantly higher among infants born with low Apgar scores (7.02 mmol/L vs 4.6mmol/L, P < 0.001). High arterial cord lactate was a significant predictor of admission to Neonatal intensive care unit (NICU) was 6.0mmol/L. Receiver operator curve (ROC) analysis suggests that lactate and pH are virtually equivalent in their correlation with adverse neonatal outcome.
CONCLUSION: Cord lactate levels are significantly related to the mode of delivery and is equivalent to cord arterial pH in predicting adverse neonatal outcomes, with similar efficacies; however, its simplicity, less sampling failure and low cost makes lactate analysis an interesting alternative in obstetric care.
PMID: 27495887 [PubMed - in process]
Acute kidney injury following coronary artery bypass graft surgery in a tertiary public hospital in Malaysia: an analysis of 1228 consecutive cases.
Med J Malaysia. 2016 Jun;71(3):126-30
Authors: Hiew KC, Sachithanandan A, Arif M, Badmanaban B, Muiz A, Faisal I, Hamdan L, Evi Diana O
BACKGROUND: Acute kidney injury (AKI) following cardiac surgery is well established but the reported incidence is variable due to varying definitions and criteria. Furthermore there is a paucity of such data from Southeast Asia.
OBJECTIVES: To determine the incidence of AKI, the associated risk factors, and its impact on early mortality and intensive care unit/hospital stay.
METHOD: This is a single centre retrospective observational study to evaluate outcomes on 1260 consecutive patients from a multi-ethnic Southeast Asian population who underwent a primary isolated coronary artery bypass graft (CABG) operation. Data was collected from the hospital's electronic database and analysed using basic descriptive statistics and logistic regression.
RESULTS: Overall incidence was 36.2% including 5.5% of patients who required renal replacement therapy (RRT). Multivariate analysis identified age, insulin-dependent diabetes mellitus (IDDM), baseline serum creatinine level (SCr), recent myocardial infarction (MI), cardiopulmonary bypass (CPB) time and intra-aortic balloon pump (IABP) use as independent risk factors for AKI. For patients who required RRT, the SCr and IDDM remained independent predictors. Early 30-day mortality (11.5% vs 0.9%) was significantly higher in patients who developed AKI following CABG. Similarly, AKI was associated with a slight but statistically significant increase in intensive care unit (ICU) and hospital stay.
CONCLUSION: Better prognostication and preventative strategies are required to better risk stratify patients undergoing CABG and optimise utilisation of limited healthcare resources.
PMID: 27495886 [PubMed - in process]
Association of Cobb angle progression and neuraxial abnormality on MRI in asymptomatic Adolescent Idiopathic Scoliosis.
Med J Malaysia. 2016 Jun;71(3):122-5
Authors: Faizah MZ, Ng KL, Te BC, Mohd Hafizuddin A, Nur Aifaa L, Nurhanisah MR, Azmi B, Hamzaini AH
BACKGROUND: Detection of neuraxial abnormality in neurologically asymptomatic adolescent idiopathic scoliosis (AIS) is crucial prior to surgery. It can only be detected on magnetic resonance imaging (MRI), which was not routinely done in this group of patient. On the other hand, whole spine radiographs for measurement of Cobb angle have been routinely included during clinic follow-up. This study aimed to determine the correlation between Cobb angle progression and neuraxial abnormality finding on MRI in asymptomatic AIS.
METHODS: A retrospective study was conducted in the Orthopaedic department of a tertiary hospital. Patients with asymptomatic AIS aged 10-20 years who attended scoliosis clinic from year 2007 to 2010 was reviewed. Patients who had whole spine MRI and two vertebral radiographs at least one year apart were further selected. Statistical analysis was done to see the association between Cobb angle progression and neuraxial abnormality on MRI.
RESULTS: The mean age at first presentation was 14.4 years old. Female (n=249) to male (n=50) ratio was 5:1. Only 19 patients fulfilled the selection criteria. There were 5 patients (26.3%) who had neuraxial abnormalities. The mean curve progression was 7.05° (range from -5° to 28°). Patients with and without neuroaxial abnormality showed mean curve progression of 0.6° and 9.36° respectively. There was no significant association between Cobb angle progression and neuroaxial abnormality (p=1.000).
CONCLUSION: Cobb angle progression is not a reliable indicator for predicting neuroaxial abnormality in patients with asymptomatic AIS. However, this study stressed the need to perform MRI prior to operation to document any associated neuraxial abnormality in clinically asymptomatic AIS patients.
PMID: 27495885 [PubMed - in process]
Community-acquired bacteremia in Paediatrics: Epidemiology, aetiology and patterns of antimicrobial resistance in a tertiary care centre, Malaysia.
Med J Malaysia. 2016 Jun;71(3):117-21
Authors: Nor Azizah A, Fadzilah MN, Mariam M, Anis Siham ZA, Ariza A, Noor Shafina MN, Anita Kaur A
INTRODUCTION: bacteremia continues to be one of the major causes of morbidity and mortality despite the existence of numerous antimicrobial agents. this study aimed to provide a Malaysian perspective on paediatric community-acquired bacteraemia based on the documentation of epidemiology and antimicrobial profile of the isolated pathogens.
METHOD: A retrospective study was conducted by analysing clinical details, blood cultures and antimicrobial susceptibility testing results in children between the ages of 0 to 13 years old, who were admitted to selayang Hospital over an 11-year period from 2001 until 2011. there were 222 bacteraemia cases and the median age was 11.7 months. the highest number (39%) of bacteraemia cases occurred between ages one month to one year. the three most commonly isolated aetiological agents were Staphylococcus aureus (17.1%), nontyphoidal Salmonella (16.2%), and Streptococcus pneumoniae (12.6%). Almost 8% of the Staphylococcus aureus isolates were methicillin resistant, while nontyphoidal Salmonella (Nts) isolates demonstrated 18.4%, 10.5% and 2.6% resistance towards ampicillin, trimethoprim-sulfamethoxazole and ciprofloxacin respectively. All Nts isolates were sensitive to ceftriaxone. Streptococcus pneumoniae isolates showed 17.9% resistance to penicillin. skin and soft tissue infections as well as lower respiratory tract infections (63.2%) were the main foci of infections in Staphylococcus aureus bacteraemia. Acute gastroenteritis (80.0%) and pneumonia (60.8%) were the main presentations of Nts and Streptococcus pneumoniae bacteraemia respectively. Overall mortality rate was 8.1%.
CONCLUSION: Knowledge on the local epidemiology and antibiotic resistance pattern serves as a significant platform in improving the empiric antibiotic therapy for patients with community acquired bacteraemia.
PMID: 27495884 [PubMed - in process]
Prophylactic bilateral internal iliac artery balloon occlusion in the management of placenta accreta: A 36-month review.
Med J Malaysia. 2016 Jun;71(3):111-6
Authors: Tan YL, Suharjono H, Lau NL, Voon HY
BACKGROUND: The contemporary obstetrician is increasingly put to the test by rising numbers of pregnancies with morbidly adherent placenta. This study illustrates our experience with prophylactic bilateral internal iliac artery occlusion as part of its management.
METHODS: Between January 2011 to January 2014, 13 consecutive patients received the intervention prior to scheduled caesarean delivery for placenta accreta. All cases were diagnosed by ultrasonography, color Doppler imaging and supplemented with MRI where necessary. The Wanda balloon(TM) catheter (Boston Scientific, Natick, MA, U.S.A) were placed in the proximal segment of the internal iliac arteries preceding surgery. This was followed by a midline laparotomy and classical caesarean section, avoiding the placenta. Both internal iliac balloons were inflated just before the delivery of fetus and deflated once haemostasis was secured. Primary outcomes measured were perioperative blood loss, blood transfusion requirement and the need for ICU admission.
RESULTS: The mean and median intraoperative blood loss were 1076mls±707 and 800mls (300-2500) respectively while mean perioperative blood loss was 1261mls±946. Just over half of the patients in our series required blood and/or blood products transfusion. Two patients (15.4%) required ICU admission.
CONCLUSION: Our study suggests that preoperative prophylactic balloon occlusion of bilateral internal iliac arteries reduces both blood loss and transfusion requirement in patients with placenta accreta, scheduled to undergo elective caesarean hysterectomy. It is an adjunct to be considered in the management of a modern day obstetric problem, although the authors are cautious about generalizing its benefit without larger, randomized trials.
PMID: 27495883 [PubMed - in process]
Generation and characterisation of human umbilical cord derived mesenchymal stem cells by explant method.
Med J Malaysia. 2016 Jun;71(3):105-10
Authors: Yusoff Z, Maqbool M, George E, Hassan R, Ramasamy R
Mesenchymal stem cells (MSCs) derived from human umbilical cord (UC) have been considered as an important tool for treating various malignancies, tissue repair and organ regeneration. Umbilical cord-derived mesenchymal stem cells (UC-MSCs) are better alternative to MSCs that derived from bone marrow (BM-MSCs) as they are regarded as medical waste with little ethical concern for research and easily culture-expanded. In this present study, the foetal distal end of human UC was utilised to generate MSC by explant method. Upon in vitro culture, adherent cells with fibroblastic morphology were generated with rapid growth kinetics. Under the respective inductive conditions, these cells were capable of differentiating into adipocytes and osteocytes; express an array of standard MSC's surface markers CD29, CD73, CD90, CD106 and MHC-class I. Further assessment of immunosuppression activity revealed that MSCs generated from UC had profoundly inhibited the proliferation of mitogen-activated T lymphocytes in a dosedependent manner. The current laboratory findings have reinforced the application of explant method to generate UCMSCs thus, exploring an ideal platform to fulfil the increasing demand of MSCs for research and potential clinical use.
PMID: 27495882 [PubMed - in process]
Cross-sectional study on knowledge of chronic kidney disease among medical outpatient clinic patients.
Med J Malaysia. 2016 Jun;71(3):99-104
Authors: Ng CY, Lee ZS, Goh KS
BACKGROUND: Chronic kidney disease (CKD) is a major health concern worldwide. There are limited studies which look into the actual knowledge level of CKD among the general population both locally and internationally. This study aims to assess the knowledge level of CKD among patients in a secondary hospital in Malaysia.
METHODS: Consecutive sampling of patients attending the Medical Outpatient Clinic was performed in this crosssectional study. Respondents were given self-administered questionnaires which contain questions on demographic characteristics and knowledge on CKD.
RESULTS: Out of 300 respondents, 78.6% (n=236) of the respondents completed the questionnaire. Majority of respondents (73.7%, n=174) scored less than 4 out of 7 marks on knowledge on CKD. Respondents who were younger, males, having higher education status, professionals/executives and earned higher monthly income were more likely to have a higher mean knowledge score of CKD. Respondents who have heard of CKD were also significantly associated with higher mean knowledge score of CKD.
CONCLUSION: The study findings suggest that our Malaysian population is still inadequately informed on CKD, especially those who are at risk of developing CKD and its complications, and also among those of the lower socioeconomic group. In order for successful primary and secondary prevention of CKD, more importance should be placed on increasing awareness on CKD among these atrisk groups.
PMID: 27495881 [PubMed - in process]