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Preview: pubmed: Med J Malaysia[Jour]

pubmed: Med J Malaysia[Jour]



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Diagnostic challenge of Burkitt's lymphoma at early age.

Diagnostic challenge of Burkitt's lymphoma at early age.

Med J Malaysia. 2017 Oct;72(5):324-326

Authors: Nor Fauziah MH, Faizah MZ, Loh CK

Abstract
A four-year-old Ibanese boy presented with subacute abdominal distension for two months duration. Ultrasound and computed tomography (CT) scan showed solid liver masses as well as bowel and intraperitoneal lesions. Initial diagnosis of intraperitoneal inflammatory process as in tuberculosis with non-liquefied liver abscess with differential diagnosis of neoplastic process was made. Liver biopsy and peritoneal fluid analysis revealed Burkitt's lymphoma (BL). We aim to highlight the diagnostic challenge of BL in this young age group emphasizing on the ultrasound and CT features of intraabdominal BL. We would also want to stress the importance of early diagnosis of BL as it is known to be the most aggressive tumour within 24 hours yet to have good survival if early diagnosis was made.

PMID: 29197894 [PubMed - in process]




Management of concurrent thoracic and abdominal aortic aneurysms.

Management of concurrent thoracic and abdominal aortic aneurysms.

Med J Malaysia. 2017 Oct;72(5):321-323

Authors: Saw ST, Feona SJ, Leong BDK

Abstract
Concurrent thoracic and abdominal aortic aneurysm is uncommon. It remains a formidable surgical challenge to vascular surgeons, as decision to treat in staged or simultaneous setting still debatable. We present, here, a case of a 62-year-old-man with asymptomatic concurrent thoracic and abdominal aortic aneurysms, which was successfully treated with two-stage hybrid endovascular repair. The aim of this case report is to discuss the treatment options available, possible associated complications and measures to prevent them.

PMID: 29197893 [PubMed - in process]




Relapse of B-cell acute lymphoblastic leukaemia presenting as right aural polyp with facial and mandibular nerves palsy.

Relapse of B-cell acute lymphoblastic leukaemia presenting as right aural polyp with facial and mandibular nerves palsy.

Med J Malaysia. 2017 Oct;72(5):318-320

Authors: Shiun Chuen C, Md Daud MK, Che Jalil NA, Hazmi H

Abstract
A patient presenting with an ear polyp is a common finding in otorhinolaryngology practice. The common causes include chronic otitis media and cholesteatoma. We report an adult female patient with a history of acute leukaemia presenting with chronic otitis media symptoms and right ear polyp. She was subsequently diagnosed as relapse of B-cell acute lymphoblastic leukaemia based on histopathological examination. The presentation may be similar to an inflammatory pathology of the middle ear, making it misleading.

PMID: 29197892 [PubMed - in process]




Management of malodour fungating wound with nanocrystalline silver coated dressing.

Management of malodour fungating wound with nanocrystalline silver coated dressing.

Med J Malaysia. 2017 Oct;72(5):316-317

Authors: Steffi W, Zaliana B, Amreen A, Nasirudin N

Abstract
Chronic exudative malodorous fungating wound of four years at the right arm due to diffuse large B cell lymphoma managed with silver dressings. In two months of application with nanocrystalline silver coated dressings, there was significant improvement in wound.

PMID: 29197891 [PubMed - in process]




Siphoning diesel: a fatal mistake.

Siphoning diesel: a fatal mistake.

Med J Malaysia. 2017 Oct;72(5):314-315

Authors: Leong WC, Cheong BM

Abstract
Diesel is commonly used as fuel for engines and is distilled from petroleum. Diesel has toxic potential and can affect multiple organs. Exposure can occur after ingestion, inhalation or through the dermal route. The practice of siphoning diesel using a rubber tubing and the mouth is common in rural communities. This can lead to accidental ingestion and aspiration. Here we report a case of a patient who accidentally ingested diesel during siphoning, which caused extensive erosion of the oral cavity and oesophagus leading to pneumomediastinum and severe chemical lung injury. The patient responded well initially to steroids and supportive care but required prolonged hospitalisation. He developed complications of nosocomial infection and succumbed 23 days after admission.

PMID: 29197890 [PubMed - in process]




Acute necrotising encephalopathy of childhood: A review of two cases.

Acute necrotising encephalopathy of childhood: A review of two cases.

Med J Malaysia. 2017 Oct;72(5):311-313

Authors: Ong SCL, Nur Azidawati AH, Liew YH, Anita S

Abstract
Acute necrotising encephalopathy of childhood (ANEC) is an uncommon disease with characteristic clinical and imaging findings. We present two cases of ANEC secondary to Respiratory Syncytial Virus (RSV) and mycoplasma infections. An eight-month-old boy presented with features of gastroenteritis but soon developed multiple episodes of seizures. Blood and CSF cultures were negative but nasopharyngeal aspirate immunofluorescence was positive for RSV. A nine-year-old girl presented with abnormal behaviour following two days of prodromal symptoms. Her serological markers implicated mycoplasma (IgM titre 1: 640). CT brain of both patients showed bilateral symmetrical thalamic hypodensities, while MRI revealed more extensive white matter involvements.

PMID: 29197889 [PubMed - in process]




Congenital arhinia - First published case in Malaysia.

Congenital arhinia - First published case in Malaysia.

Med J Malaysia. 2017 Oct;72(5):308-310

Authors: Ng RL, Rajapathy K, Ishak Z

Abstract
Congenital arhinia is one of the rare craniofacial malformation that may cause severe respiratory distress at birth due to upper airway obstruction. Our patient, whose abnormalities were only detected after delivery in our centre, is the first reported case of congenital arhinia in Malaysia. Contrary to popular belief that neonates are obligate nasal breather, our patient adapted well to breathing through mouth before an elective tracheostomy was performed on day four of life.

PMID: 29197888 [PubMed - in process]




Important differential in a patient presenting with neuropsychiatric symptoms: Anti-N-Methyl-D-Aspartate receptor encephalitis.

Important differential in a patient presenting with neuropsychiatric symptoms: Anti-N-Methyl-D-Aspartate receptor encephalitis.

Med J Malaysia. 2017 Oct;72(5):306-307

Authors: Low JM

Abstract
Anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis is an immune mediated condition, which remains relatively unknown in Malaysia outside tertiary hospitals with neurology unit. It is often misdiagnosed as a psychiatric illness before definitive treatment is instituted. We report here an 18-year-old man who initially presented to the psychiatry unit before he was subsequently diagnosed as having anti-NMDAR encephalitis. To our knowledge, this is the first reported case of anti-NMDAR encephalitis in the east coast of Peninsular Malaysia.

PMID: 29197887 [PubMed - in process]




Bullying and truancy: Predictors to sexual practices among school-going adolescents in Malaysia - a cross-sectional study.

Bullying and truancy: Predictors to sexual practices among school-going adolescents in Malaysia - a cross-sectional study.

Med J Malaysia. 2017 Oct;72(5):298-305

Authors: Azmawati MN, Dalila R, Idris IB, Hod R

Abstract
INTRODUCTION: Adolescents' involvement in sexual practices are becoming a major public health concern in Malaysia. This study aims to determine the prevalence of sexual practices among Malaysian school-going adolescents and its predictive factors.
METHODS: A cross-sectional study was carried out from April 2012 till September 2012 among 16-year-old school adolescents from two different schools. They were selected through simple random sampling and these adolescents answered a self-administered questionnaire consisting of three sections i.e. socio-demography, risk-taking behaviours and family-adolescents relationship. Data were analysed using Pearson Chi-Square test while Simple Logistic Regression and Multiple Logistic Regression were applied to determine the predictive factors.
RESULTS: The prevalence of sexual practices among the adolescents was 30.1% in which they were either involved in pornography (26.8%), pre-sexual activities (8.5%) or premarital sex (2.9%). Six predictive factors associated with sexual practices among this age group were identified which were male (adjusted Odds Ratio (aOR) 2.7, 95% Confidence Interval (95%CI) 1.4 to 2.5), truancy (aOR 2.3, 95%CI 1.3 to 4.2), bully (aOR 3.5, 95%CI 1.7 to 7.3), hanging out (aOR 2.8, 95% 1.4 to 5.6), staying out late (aOR 3.2, 95%CI 1.5 to 6.8) and conflict with family (aOR 4.1, 95%CI 1.9 to 8.9).
DISCUSSION: Asian background differs from the western countries and findings of this study may suggest suitable intervention programmes that can prevent high-risk sexual practices among Asian school-going adolescents.

PMID: 29197886 [PubMed - in process]




The predicting roles of reasons for living and social support on depression, anxiety and stress among young people in Malaysia.

The predicting roles of reasons for living and social support on depression, anxiety and stress among young people in Malaysia.

Med J Malaysia. 2017 Oct;72(5):291-297

Authors: Amit N, Ibrahim N, Aga Mohd Jaladin R, Che Din N

Abstract
INTRODUCTION: This research examined the predicting roles of reasons for living and social support on depression, anxiety and stress in Malaysia.
METHOD: This research was carried out on a sample of 263 participants (age range 12-24 years old), from Klang Valley, Selangor. The survey package comprises demographic information, a measure of reasons for living, social support, depression, anxiety and stress. To analyse the data, correlation analysis and a series of linear multiple regression analysis were carried out.
RESULTS: Findings showed that there were low negative relationships between all subdomains and the total score of reasons for living and depression. There were also low negative relationships between domain-specific of social support (family and friends) and total social support and depression. In terms of the family alliance, self-acceptance and total score of reasons for living, they were negatively associated with anxiety, whereas family social support was negatively associated with stress. The linear regression analysis showed that only future optimism and family social support found to be the significant predictors for depression. Family alliance and total reasons for living were significant in predicting anxiety, whereas family social support was significant in predicting stress.
CONCLUSION: These findings have the potential to promote awareness related to depression, anxiety, and stress among youth in Malaysia.

PMID: 29197885 [PubMed - in process]




Comparison between FEV1/FEV6 and FEV1/FVC as screening of chronic obstructive pulmonary disease.

Comparison between FEV1/FEV6 and FEV1/FVC as screening of chronic obstructive pulmonary disease.

Med J Malaysia. 2017 Oct;72(5):286-290

Authors: Ng SC, Abu Samah F, Helmy K, Sia KK

Abstract
OBJECTIVE: To compare FEV1/FEV6 to the standard spirometry (FEV1/FVC) as a screening tool for COPD.
METHODS: This cross-sectional study was conducted at Hospital Tuanku Fauziah, Perlis, Malaysia from August 2015 to April 2016. FEV1/FEV6 and FEV1/FVC results of 117 subjects were analysed. Demographic data and spirometric variables were tabulated. A scatter plot graph with Spearman's correlation was constructed for the correlation between FEV1/FEV6 and FEV1/FVC. The sensitivity, specificity, positive and negative predictive values of FEV1/FEV6 were determined with reference to the gold standard of FEV1/FVC ratio <0.70. Receiver-operator characteristic (ROC) curve analysis and Kappa statistics were used to determine the FEV1/FEV6 ratio in predicting an FEV1/FVC ratio <0.70.
RESULTS: Spearman's correlation with r = 0.636 (P<0.001) was demonstrated. The area under the ROC curve was 0.862 (95% confidence interval [CI]: 0.779 - 0.944, P<0.001). The FEV1/FEV6 cut-off with the greatest sum of sensitivity and specificity was 0.75. FEV1/FEV6 sensitivity, specificity, positive and negative predictive values were 93.02%, 67.74%, 88.89% and 77.78% respectively. There was substantial agreement between the two diagnostic cut-offs (κ = 0.634; 95% CI: 0.471 - 0.797, P<0.001) CONCLUSIONS: The FEV1/FEV6 ratio can be considered to be a good alternative to the FEV1/FVC ratio for screening of COPD. Larger multicentre study and better education on spirometric techniques can validate similar study outcome and establish reference values appropriate to the population being studied.

PMID: 29197884 [PubMed - in process]




Clinical characteristics, treatment and 2-year outcomes in Malaysian and Bruneian patients with stable coronary artery within the worldwide CLARIFY registry.

Clinical characteristics, treatment and 2-year outcomes in Malaysian and Bruneian patients with stable coronary artery within the worldwide CLARIFY registry.

Med J Malaysia. 2017 Oct;72(5):282-285

Authors: Chee KH, Choo GH, Jamaluddin ANB, Mahendran K, Greenlaw N, Chandran A

Abstract
INTRODUCTION: The on-going, international, prospective, observational, longitudinal CLARIFY registry is investigating the demographics, clinical profiles, management and outcomes of patients with stable coronary artery disease (CAD). This paper assesses baseline characteristics, treatment, and clinical outcomes at two years' follow-up of Malaysian/Bruneian patients compared with the overall registry population.
METHOD: Between November 2009 and July 2010, outpatients from 45 countries who met the criteria for stable CAD were recruited into the registry. Baseline characteristics were documented at enrolment, and patients were reassessed during their annual visits over a five-year follow-up period. Key outcomes measured were sudden death and cardiovascular (CV) death, non-CV death and CV morbidity.
RESULTS: At baseline, 33,283 patients were available for analysis within the registry; 380 and 27 were Malaysians and Bruneians, respectively. The mean ages of Malaysian/Bruneian patients and the rest of the world (RoW) were 57.83 ±9.98 years and 64.23 ± 10.46 years, respectively (p<0.001). The median body mass index values were 26.6 (24.4-29.6) kg/m2 and 27.3 (24.8-30.3) kg/m2, respectively (p=0.014). Malaysian/Bruneian patients had lower rates of myocardial infarction (54.55% versus 59.76%, p=0.033) and higher rates of diabetes (43.24% versus 28.99%, p<0.001) and dyslipidaemia (90.42% versus 74.66%, p<0.001) compared with the RoW. Measured clinical outcomes in Malaysian and Bruneian patients at 2-years follow-up were low and generally comparable to the RoW.
CONCLUSION: Malaysian/Bruneian patients with stable CAD tend to be younger with poorer diabetic control compared with the RoW. However, they had similar outcomes as the main registry following two years of treatment.

PMID: 29197883 [PubMed - in process]




Islamic medical jurisprudence syllabus: A Review in Saudi Arabia.

Islamic medical jurisprudence syllabus: A Review in Saudi Arabia.

Med J Malaysia. 2017 Oct;72(5):278-281

Authors: Chamsi-Pasha H, Albar MA

Abstract
INTRODUCTION: The ever-increasing technological advances of Western medicine have created new ethical issues awaiting answers and response. The use of genetic therapy, organ transplant, milk-banking, end-of-life care and euthanasia are of paramount importance to the medical students and need to be addressed.
METHODS: A series of searches were conducted of Medline databases published in English between January 2000 and January 2017 with the following keywords: medical ethics, syllabus, Islam, jurisprudence.
RESULTS: Islamic medical jurisprudence is gaining more attention in some medical schools. However, there is still lack of an organised syllabus in many medical colleges.
CONCLUSION: The outlines of a syllabus in Islamic medical jurisprudence including Islamic values and moral principles related to both the practice and research of medicine are explored.

PMID: 29197882 [PubMed - in process]




What are the direct medical costs of managing Type 2 Diabetes Mellitus in Malaysia?

What are the direct medical costs of managing Type 2 Diabetes Mellitus in Malaysia?

Med J Malaysia. 2017 Oct;72(5):271-277

Authors: Feisul IM, Azmi S, Mohd Rizal AM, Zanariah H, Nik Mahir NJ, Fatanah I, Aizuddin AN, Goh A

Abstract
INTRODUCTION: An economic analysis was performed to estimate the annual cost of diabetes mellitus to Malaysia.
METHODS: We combined published data and clinical pathways to estimate cost of follow-up and complications, then calculated the overall national cost. Costs consisted of diabetes follow-up and complications costs.
RESULTS: Patient follow-up was estimated at RM459 per year. Complications cost were RM42,362 per patient per year for nephropathy, RM4,817 for myocardial infarction, RM5,345 for stroke, RM3,880 for heart failure, RM5,519 for foot amputation, RM479 for retinopathy and RM4,812 for cataract extraction.
CONCLUSION: Overall, we estimated the total cost of diabetes as RM2.04 billion per year for year 2011 (both public and private sector). Of this, RM1.40 billion per year was incurred by the government. Despite some limitations, we believe our study provides insight to the actual cost of diabetes to the country. The high cost to the nation highlights the importance of primary and secondary prevention.

PMID: 29197881 [PubMed - in process]




Construct validity and internal consistency reliability of the Malay version of the 21-item depression anxiety stress scale (Malay-DASS-21) among male outpatient clinic attendees in Johor.

Construct validity and internal consistency reliability of the Malay version of the 21-item depression anxiety stress scale (Malay-DASS-21) among male outpatient clinic attendees in Johor.

Med J Malaysia. 2017 Oct;72(5):264-270

Authors: Rusli BN, Amrina K, Trived S, Loh KP, Shashi M

Abstract
BACKGROUND: The 21-item English version of the Depression Anxiety Stress Scale (DASS-21) has been proposed as a method for assessing self-perceived depression, anxiety and stress over the past week in various clinical and nonclinical populations. Several Malay versions of the DASS-21 have been validated in various populations with varying success. One particular Malay version has been validated in various occupational groups (such as nurses and automotive workers) but not among male clinic outpatient attendees in Malaysia.
OBJECTIVE: To validate the Malay version of the DASS-21 (Malay-DASS-21) among male outpatient clinic attendees in Johor.
METHODS: A validation study with a random sample of 402 male respondents attending the outpatient clinic of a major public outpatient clinic in Johor Bahru and Segamat was carried out from January to March 2016. Construct validity of the Malay-DASS-21 was examined using Exploratory Factor Analysis (KMO = 0.947; Bartlett's test of sphericity is significant, p<0.001) through Principal Component Analysis and orthogonal (varimax) rotation with Kaiser Normalization to confirm the psychometric properties of the Malay-DASS- 21 and the internal consistency reliability using Cronbach's alpha.
RESULTS: Construct validity of the Malay-DASS-21 based on eigenvalues and factor loadings to confirm the three factor structure (depression, anxiety, and stress) was acceptable. The internal consistency reliability of the factor construct was very impressive with Cronbach's alpha values in the range of 0.837 to 0.863.
CONCLUSIONS: The present study showed that the Malay- DASS-21 has acceptable psychometric construct and high internal consistency reliability to measure self-perceived depression, anxiety and stress over the past week in male outpatient clinic attendees in Johor. Further studies are necessary to revalidate the Malay-DASS-21 across different populations and cultures, and using confirmatory factor analyses.

PMID: 29197880 [PubMed - in process]




Corticosteroid-induced leukocytosis in pregnancy: A prospective observational study.

Corticosteroid-induced leukocytosis in pregnancy: A prospective observational study.

Med J Malaysia. 2017 Oct;72(5):259-263

Authors: Voon HY, Leong MS, Li CW, Bujang A, Suharjono H

Abstract
BACKGROUND: In the course of managing preterm labour, increasing trends of total white cell count raises concern for the obstetrician, suggesting a possible underlying infectious aetiology. Although mild leukocytosis is expected in pregnancy, the patterns of increment after corticosteroid administration are not well described beyond animal models and in a small number of human studies.
METHODS: Seventy-three consecutive patients who required antenatal corticosteroids for either preterm labour or prelabour caesarean section were recruited and given a standard course of 12mg dexamethasone phosphate, twelve hours apart. Venous blood samples were taken before administration, at six hours and 36 hours after the first dose of dexamethasone.
RESULTS: The total white count trend was 10.31±2.62 at baseline, 11.44±3.05 at six hours and 12.20±3.49 at 36 hours. Neutrophil-lymphocyte ratio was 3.60±1.31, 8.73±3.63 and 3.24±1.49 respectively, reflecting relative neutrophilia and lymphopenia which normalised by 36 hours.
CONCLUSION: In contrast to previous studies, we found only a slight increment in total white cell count of about 10%. The marginal changes described in our study would not normally raise any clinical concern, although vigilance should be exercised if higher levels were observed.

PMID: 29197879 [PubMed - in process]