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Preview: pubmed: Med J Malaysia[Jour]

pubmed: Med J Malaysia[Jour]



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Pulmonary actinomycosis masquerading as aspergilloma.
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Pulmonary actinomycosis masquerading as aspergilloma.

Med J Malaysia. 2017 Apr;72(2):147-149

Authors: Rosdina Z, Nurul Yaqeen ME, Hanafiah M, Nor Salmah B

Abstract
We report a case of a 34-year-old man who was initially treated as community acquired pneumonia following a three-month-history of productive cough, loss of weight and loss of appetite. However, three months after discharged from the hospital, he presented again with worsening respiratory symptoms and radiological evidence of a lung cavitation with intracavitary lesion resembling an aspergilloma associated with surrounding consolidation. Unfortunately, he remained symptomatic despite on antifungal therapy. The repeat computed-tomography demonstrated persistent cavitating lesion with development of necrotising pneumonia. He underwent lobectomy and the histopathological analysis of the resected specimen however revealed the diagnosis of actinomycosis.

PMID: 28473686 [PubMed - in process]




Idiopathic Internal Thoracic Artery (ITA) Pseudoaneurysm treated with Endovascular Embolization.
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Idiopathic Internal Thoracic Artery (ITA) Pseudoaneurysm treated with Endovascular Embolization.

Med J Malaysia. 2017 Apr;72(2):144-146

Authors: Wong WJ, Leong BDK, Mak CH

Abstract
A 44-year-old female was diagnosed with an ITA pseudoaneurysm in the right supraclavicular fossa. She was successfully treated with endovascular embolization. The challenges of diagnosis and treatment are discussed.

PMID: 28473685 [PubMed - in process]




A case series of dermatological emergencies - Erythroderma.
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A case series of dermatological emergencies - Erythroderma.

Med J Malaysia. 2017 Apr;72(2):141-143

Authors: Tan TL, Chung WM

Abstract
Erythroderma can be life-threatening, primarily because of its metabolic burden and complications. It is mandatory to establish its etiopathology in order to facilitate precise and definitive management. This disorder may be the morphologic presentation of a variety of cutaneous and systemic diseases. Detailed history and thorough work-up is therefore essential. Management of erythroderma involves multi-disciplines with progress monitoring especially on signs and symptoms suggestive of acute skin failure induced complications. Early diagnosis and referral of erythroderma to centres with dermatological services is crucial and will directly affect the outcome of the patients.

PMID: 28473684 [PubMed - in process]




Positron emission mammography is a useful adjunct in assessment of dense breasts.
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Positron emission mammography is a useful adjunct in assessment of dense breasts.

Med J Malaysia. 2017 Apr;72(2):138-140

Authors: Kumar SK, Trujillo PB, Ucros GR

Abstract
Worldwide breast cancer remains as the most common malignancy in women and the numbers who form a subgroup with dense breast parenchyma are substantial. In addition to mammography, the adjuncts used for further evaluation of dense breasts have been anatomically based modalities such as ultrasound and magnetic resonance imaging. The practice of functionally based imaging of breasts is relatively new but has undergone rapid progress over the past few years with promising results. The value of positron emission mammography is demonstrated in patients with dense breasts and mammographically occult disease.

PMID: 28473683 [PubMed - in process]




Bilateral microtia, canal atresia and aplasia of cochleovestibular nerve.
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Bilateral microtia, canal atresia and aplasia of cochleovestibular nerve.

Med J Malaysia. 2017 Apr;72(2):135-137

Authors: Asma A, Roslenda AR, Fadzilah I, Mazita A, Marina MB, Ab Aziz A

Abstract
A six-month-old baby with congenital patent ductus arteriosus (PDA), bilateral microtia and canal atresia was referred for hearing assessment. The audiology assessment revealed bilateral profound hearing loss, which is atypical for a case of pure canal atresia. Imaging was performed much earlier than usual and, as suspected, the patient also had bilateral severe inner ear anomaly. It is extremely rare for a person to have both external and inner ear anomaly because of the different embryological origin. The only suitable hearing rehabilitation option for this kind of patients is brainstem implant. However, the parents had opted for sign language as a form of communication.

PMID: 28473682 [PubMed - in process]




Pregnancy and Dumping Syndrome post-bariatric surgery: a case report.
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Pregnancy and Dumping Syndrome post-bariatric surgery: a case report.

Med J Malaysia. 2017 Apr;72(2):133-134

Authors: Edawati DE, Abigail J, Mardiana K, Ming-Cheng C, Harris NS

Abstract
This case report discusses dumping syndrome in the postbariatric mother. Diagnostically a challenge, the symptoms of postprandial hypoglycaemia mimic common early gestation complaints and may go undiagnosed, thus requiring a high index of suspicion. As weight-loss surgery gains traction, it is pertinent to note at booking and followups. The pregnancy is at-risk and multidisciplinary team management is central. The mainstay of management remains diet modification. There have been case reports of successful medical treatment of dumping syndrome in pregnancy with good maternal and fetal outcomes. However, more data is needed regarding the usage of these medical treatments in pregnancy.

PMID: 28473681 [PubMed - in process]




Bilateral central retinal vein occlusion in a pregnant lady.
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Bilateral central retinal vein occlusion in a pregnant lady.

Med J Malaysia. 2017 Apr;72(2):130-132

Authors: Loh MA, Abirami S, Chong MF

Abstract
We report a rare case of central retinal vein occlusion (CRVO) in pregnancy. There was dramatic deterioration of vision in both eyes through pregnancy despite repeated attempts of laser treatment and systemically controlled diabetes. Significant improvement was noted postpartum. Pregnancy is an aggravated factor of bilateral CRVO.

PMID: 28473680 [PubMed - in process]




Epiploic Appendagitis: An uncommon surgical diagnosis.
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Epiploic Appendagitis: An uncommon surgical diagnosis.

Med J Malaysia. 2017 Apr;72(2):128-129

Authors: Michael A, Zakry Y, Hanif H

Abstract
Epiploic appendagitis or appendices epiploicae, is a rare cause of abdominal pain in patients with mild signs of abdominal pathology. It mimics diverticulitis or appendicitis clinically as there are no pathognomonic features. It is a surgical diagnosis presenting with localised, sharp, acute abdominal pain, not associated with symptoms like nausea, vomiting, fever or suggestive laboratory values. With the availability of abdominal CT scans and ultrasound, it will frequently be a differential diagnosis preventing unnecessary surgery for patients. However, it may be erroneous and therefore clinical judgement is of paramount importance. This report highlights this rare presentation and identifies management guidelines.

PMID: 28473679 [PubMed - in process]




Antenatal diagnosis and management of foetal intestinal volvulus.
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Antenatal diagnosis and management of foetal intestinal volvulus.

Med J Malaysia. 2017 Apr;72(2):126-127

Authors: Yip KW, Cheng YKY, Leung TY

Abstract
In-utero intestinal volvulus is a rare but potential life threatening foetal complications. It is a surgical emergency and delay in diagnosis or treatment can increase the morbidity and mortality to the foetus. We report a case of mild foetal bowel dilatation diagnosed at 21 weeks of gestation. She was closely follow up and at 31 weeks of gestation, in-utero intestinal volvulus was diagnosed with the characteristic 'whirlpool' sign on ultrasound examination. This case emphasises the importance of early recognition and quick decision to delivery when intestinal volvulus is diagnosed. This enabled early surgical intervention to prevent further foetal morbidity.

PMID: 28473678 [PubMed - in process]




Antithrombotic effects of hydroxychloroquine in a pregnant patient with Antiphospholipid syndrome and recurrent venous thromboembolism.
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Antithrombotic effects of hydroxychloroquine in a pregnant patient with Antiphospholipid syndrome and recurrent venous thromboembolism.

Med J Malaysia. 2017 Apr;72(2):124-125

Authors: Gan SP, Ong SG

Abstract
A pregnant woman with antiphospholipid syndrome presented with repeated venous thromboembolism (VTE) in the first and second trimesters of pregnancy despite receiving combination therapy with low-molecular-weight heparin and aspirin. The addition of hydroxychloroquine prevented further VTE recurrence, thus demonstrating its potential antithrombotic effects.

PMID: 28473677 [PubMed - in process]




Subcutaneous mycosis presenting as a non- healing left calf ulcer in an immunocompromised patient.
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Subcutaneous mycosis presenting as a non- healing left calf ulcer in an immunocompromised patient.

Med J Malaysia. 2017 Apr;72(2):122-123

Authors: Tang ASO, Yong KY, Wong J, Chua HH, Chew LP

Abstract
This is a case report of subcutaneous mycosis presenting as a non-healing left calf ulcer in an immunocompromised patient. Traumatic inoculation of the causative agent is the most likely route of infection. The diagnosis requires a detailed history and high clinical suspicion, confirmed by histopathological examination. The management requires a multidisciplinary team approach involving surgeon, pathologist, physician sub-specialised in infectious disease, wound care nursing team as well as social support services. The literature review recommended that the treatment of choice for such infection is surgical debridement in addition to optimal antifungal therapy.

PMID: 28473676 [PubMed - in process]




Impact of virtual reality games on psychological well-being and upper limb performance in adults with physical disabilities: A pilot study.
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Impact of virtual reality games on psychological well-being and upper limb performance in adults with physical disabilities: A pilot study.

Med J Malaysia. 2017 Apr;72(2):119-121

Authors: Singh DKA, Rahman NNA, Seffiyah R, Chang SY, Zainura AK, Aida SR, Rajwinder KHS

Abstract
INTRODUCTION: There is limited information regarding the effects of interactive virtual reality (VR) games on psychological and physical well-being among adults with physical disabilities. We aimed to examine the impact of VR games on psychological well-being, upper limb motor function and reaction time in adults with physical disabilities.
METHODS: Fifteen participants completed the intervention using Wii VR games in this pilot study. Depressive, Anxiety and Stress Scales (DASS) and Capabilities of Upper Extremity (CUE) questionnaires were used to measure psychological well-being and upper limb motor function respectively. Upper limb reaction time was measured using reaction time test.
RESULTS: Results showed that there was a significant difference (p<0.05) in DASS questionnaire and average reaction time score after intervention.
CONCLUSION: There is a potential for using interactive VR games as an exercise tool to improve psychological wellbeing and upper limb reaction time among adults with disabilities.

PMID: 28473675 [PubMed - in process]




Contact sensitisation in adults: a 5-year retrospective review in hospital Kuala Lumpur.
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Contact sensitisation in adults: a 5-year retrospective review in hospital Kuala Lumpur.

Med J Malaysia. 2017 Apr;72(2):113-118

Authors: How KN, Tang MM, Kaur R, Johar A

Abstract
BACKGROUND: The pattern of contact sensitisation should be monitored in order to detect the changing trend of sensitising allergens. We aim to evaluate contact sensitisation in adults suspected to have allergic contact dermatitis.
METHODS: This is a five-year retrospective review on contact sensitisation in adults patch-tested with the European Standard and extended series between 2011 and 2015 in the Department of Dermatology, Hospital Kuala Lumpur.
RESULTS: There were 689 adults (M:F= 1:2.04; mean age 40.5 years) who were patch-tested. The majority (175, 25.4%) were white collar workers and 118 (17.1%) were healthcare workers. The provisional diagnoses of patients included contact dermatitis (80.8%); endogenous eczema (7.9%); hand eczema (3.2%); hand and foot eczema (3.5%); foot eczema (1.4%) and photodermatitis (1.2%). The allergens selected for testing were based on past and present history of exposure. Almost all (688, 99.8%) were patch-tested with the European standard allergens and 466 (67.6%) were tested with the extended series. About three quarter (528, 76.6%) developed at least one positive reaction. The top five most frequent reactions were to nickel sulphate (35.3%); potassium dichromate (16.5%); methylchloroisothiazolinone (12.9%), fragrance mix I (12.6%), and cobalt chloride (10.2%). The commonest sensitisations identified in the extended series were palladium chloride (23/105, 21.9%), stannous chloride (18/85, 21.2%), miconazole (7/44, 15.9%), gold(I)sodium thiosulfate (16/105, 15.2%) and thimerosal (29/202, 14.4%).
CONCLUSION: Contact sensitisation was detected in 76.6% of adults patch-tested. Nickel sulphate was found to be the most frequently sensitising allergen. The rising prevalence of methylchloroisothiazolinone/methylisothiazolinone sensitization poses significant concern.

PMID: 28473674 [PubMed - in process]




Feasibility of Implementing Chronic Care Model in the Malaysian Public Primary Care Setting.
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Feasibility of Implementing Chronic Care Model in the Malaysian Public Primary Care Setting.

Med J Malaysia. 2017 Apr;72(2):106-112

Authors: Ariffin F, Ramli AS, Daud MH, Haniff J, Abdul-Razak S, Selvarajah S, Lee VK, Tong SF, Bujang MA

Abstract
INTRODUCTION: Non-communicable diseases (NCD) is a global health threat. the Chronic Care Model (CCM) was proven effective in improving NCD management and outcomes in developed countries. Evidence from developing countries including Malaysia is limited and feasibility of CCM implementation has not been assessed. this study intends to assess the feasibility of public primary health care clinics (PHC) in providing care according to the CCM.
METHODOLOGY: A cross-sectional survey was conducted to assess the public PHC ability to implement the components of CCM. All public PHC with Family Medicine Specialist in Selangor and Kuala Lumpur were invited to participate. A site feasibility questionnaire was distributed to collect site investigator and clinic information as well as delivery of care for diabetes and hypertension.
RESULTS: there were a total of 34 public PHC invited to participate with a response rate of 100%. there were 20 urban and 14 suburban clinics. the average number of patients seen per day ranged between 250-1000 patients. the clinic has a good mix of multidisciplinary team members. All clinics had a diabetic registry and 73.5% had a hypertensive registry. 23.5% had a dedicated diabetes and 26.5% had a dedicated hypertension clinic with most clinic implementing integrated care of acute and NCD cases.
DISCUSSION: the implementation of the essential components of CCM is feasible in public PHCs, despite various constraints. Although variations in delivery of care exists, majority of the clinics have adequate staff that were willing to be trained and are committed to improving patient care.

PMID: 28473673 [PubMed - in process]




Colistin-associated nephrotoxicity among patients in intensive care units (ICU) of hospitals in Selangor.
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Colistin-associated nephrotoxicity among patients in intensive care units (ICU) of hospitals in Selangor.

Med J Malaysia. 2017 Apr;72(2):100-105

Authors: Rashizal Sazli MR, Syed Mohamed AF, Wan Mazuan WM, Ling SM, Mahmud A, Amin Nordin S

Abstract
INTRODUCTION: The increasing trend of extensively drugresistant gram negative bacteria responsible for nosocomial infections has prompted resurgence colistin usage. Colistin-induced nephrotoxicity is a concern with disparity in the reported rates between previous studies. This study aims to evaluate colistin-induced nephrotoxicity among Malaysian population.
METHODS: The medical records of ICU patients receiving colistin therapy in Hospital Serdang and Hospital Sungai Buloh from 2010 to 2012 were retrospectively reviewed. Demographics data, treatment characteristic as well as culture result and creatinine level were documented. Nephrotoxicity was determined based on RIFLE criteria.
RESULTS: A total of 100 patients were included. Median daily dose, cumulative dose and duration of colistin therapy were 3.0 MIU (IQR: 4, range 1-12), 17.8 MIU (IQR: 31.5, range 2-180) and seven days (IQR: 4, range 1-30). Nephrotoxicity was found in 23% of the study population. All cases were reversible but marginally associated with higher mortality. No statistical association exist between age, gender and race as well as administration routes with nephrotoxicity by univariable analysis. The association of dose and duration with nephrotoxicity was also not significant by univariable analysis. After adjustment for confounders, statistical association between the independent variables and dependent variable remains not significant.
CONCLUSION: Lower dose and shorter duration in local settings contribute to lack of association between colistin therapy and nephrotoxicity in this study. Higher dosing regimen with loading dose application has been introduced in the latest National Antibiotic Guideline. Further evaluation of colistin-induced nephrotoxicity and potential risk factors is therefore warranted.

PMID: 28473672 [PubMed - in process]




Prevalence of menopausal symptoms, its effect to quality of life among Malaysian women and their treatment seeking behaviour.
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Prevalence of menopausal symptoms, its effect to quality of life among Malaysian women and their treatment seeking behaviour.

Med J Malaysia. 2017 Apr;72(2):94-99

Authors: Abdullah B, Moize B, Ismail BA, Zamri M, Mohd Nasir NF

Abstract
INTRODUCTION: This study aimed to determine the prevalence of menopausal symptoms, its effect to the quality of life and their treatment seeking behaviour in a multiracial community in Malaysia.
METHODS: This is a cross-sectional study involving postmenopausal women in Klang Valley, Malaysia. Data was obtained by face-to-face interview using standardised questionnaires on sociodemographic data, Menopause Rating Scale questionnaire, effect to quality of life and treatment sought.
RESULTS: A total of 258 women, including Malays (82%), Indians (14.1%) and Chinese (3.9%) were recruited. The median age was 58 (range 45-86) years old. Joint and muscular discomfort (73.3%) and fatigue (59.3%) were the most prevalent symptoms. Significant association with ethnicity were demonstrated with Malays was found to have 3.1 times higher incidence of sexual problems than Indians, (Odds Ratio (OR) 3.103; 95%CI 1.209, 7.967) and Indian had 2.6 times higher incidence of irritability compared to Malays (OR 2.598; 95%CI 1.126, 5.992). Fifty-two percent of women felt that menopausal symptoms affected their quality of life but there were only 2.7% who were severely affected. There were 24.8% of women who sought treatment and only 20.3% of those who took hormone replacement therapy. There was no significant association found between their treatment seeking behaviour in association with ethnicity, age, parity, marital and occupational status.
CONCLUSION: Menopausal symptoms were prevalent among menopausal women, although only a small group of women who were severely affected. There was a lack of tendency in seeking treatment for menopausal symptoms among the women.

PMID: 28473671 [PubMed - in process]




Total percutaneous endovascular aneurysm repair (pEVAR): the initial experience in Hospital Kuala Lumpur.
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Total percutaneous endovascular aneurysm repair (pEVAR): the initial experience in Hospital Kuala Lumpur.

Med J Malaysia. 2017 Apr;72(2):91-93

Authors: Leong BDK, Govindarajanthran N, Hafizan TM, Tan KL, Hanif H, Zainal AA

Abstract
INTRODUCTION: There has been a paradigm shift in the treatment of AAA with the advent of endovascular aneurysm repair (EVAR). Rapid progress and evolution of endovascular technology has brought forth smaller profile devices and closure devices. Total percutaneous endovascular aneurysm repair (pEVAR) involves the usage of suture-mediated closure devices (SMCDs) at vascular access sites to avoid a traditional surgical cutdown.
MATERIALS AND METHODS: We retrospectively reviewed our experience of pEVAR between April 2013 and July 2014. Primary success of the procedure was defined as closure of a common femoral artery (CFA) arteriotomy without the need for any secondary surgical or endovascular procedure within 30 days.
RESULTS: In total there were 10 pEVAR cases performed in the study period, one case in Queen Elizabeth Hospital during visiting vascular service. Patients have a mean age of 73.4 year old (66-77 year old) The mean abdominal aortic size was 7.2 cm (5.6-10.0cm). Mean femoral artery diameter was 9.0 mm on the right and 8.9 mm on the left. Mean duration of surgery was 119 minutes (98- 153 minutes). 50% of patients were discharged at post-operative day one, 30%- day two and 20%- day three. Primary success was achieved in 9 patients (90%) or in 19 CFA closures (95%). No major complication was reported.
DISCUSSION: We believe that with proper selection of patients undergoing EVAR, pEVAR offers a better option of vascular access with shorter operative time, less post- operative pain, shorter hospital stay and minimises the potential complications of a conventional femoral cutdown.

PMID: 28473670 [PubMed - in process]




Resilient healthcare in patient safety.
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Resilient healthcare in patient safety.

Med J Malaysia. 2017 Apr;72(2):89-90

Authors: Lee YF

Abstract
No abstract available.

PMID: 28473669 [PubMed - in process]