Axillary accessory breast carcinoma masquerading as axillary abscess: a case report.
Med J Malaysia. 2016 Dec;71(6):370-371
Authors: Lim SY, Jee SL, Gee T, Nor Aina E
Accessory breast is a frequently seen developmental breast abnormality, commoner among Asians than Caucasians. This ectopic breast tissue shares many similarities as the normal breast tissue, and although subjected to the same pathological processes, accessory breast carcinoma is rare. As locations of the accessory breast may be variable, detection of pathological lesions through clinical examinations and standard diagnostic tools (i.e., mammogram) can be difficult. Staging and management should be tailored-made according to the location of the accessory breast as well as its known pattern of lymphatic drainage. We report a case of an intra-ductal carcinoma occurring in an axillary accessory breast.
PMID: 28087969 [PubMed - in process]
Thymic carcinoma presenting with an unusual and delayed metastasis to the neural foramen, mimicking thoracic spinal radiculopathy.
Med J Malaysia. 2016 Dec;71(6):368-369
Authors: Low HM, Wong CF, H'ng MW
We report a case of metastatic thymic carcinoma which presented as an enhancing mass located in the neural foramen of the thoracic spine. More common tumours which arise in the neural foramen would include a neurogenic tumour or developmental anomalies such as a foregut duplication cyst. This case is singular firstly because the lesion present as radiculopathy which mimics a neurogenic tumour. Secondly, the presentation was unusually delayed as the patient presented to our centre more than a decade after the resection of the primary tumour in another institution.
PMID: 28087968 [PubMed - in process]
Periampullary Carcinoma with Penile Metastasis.
Med J Malaysia. 2016 Dec;71(6):366-367
Authors: Pui WC, Nik Azim NA
Periampullary carcinoma metastases are usually located at regional nodes, adjacent organs, liver or lung. On the other hand, metastatic penile cancer is uncommon. Penile metastasis usually originates from pelvic region with prostate and bladder being the most frequent primary location. We present a very rare case of periampullary carcinoma with penile metastasis in a 49-year-old man. He initially presented with early ampullary type periampullary carcinoma and had pyloric preserving pancreatoduodenectomy and adjuvant chemotherapy. However, after six years of uneventful follow up, he presented with a penile lesion which was confirmed to be pancreatic metastasis. He was started on chemotherapy but passed away two months later. Ampullary carcinoma type of periampullary carcinoma usually presents early with favourable prognosis. However, tumour recurrence can present much later after definitive treatment and at a rare site such as penis with generally poor outcome.
PMID: 28087967 [PubMed - in process]
Gastric ulcer that turned out to be metastasis of a synovial sarcoma: A case report and literature review.
Med J Malaysia. 2016 Dec;71(6):363-365
Authors: Samuel T, Norly S, Ros'aini P
Primary gastrointestinal synovial sarcoma or its metastases to the gastrointestinal tract is rare. Here we present a case of 56-year-old gentleman with left thigh synovial sarcoma and gastric metastases along with the literature review.
PMID: 28087966 [PubMed - in process]
Hypopharyngeal cancer masquerading as a thyroid mass.
Med J Malaysia. 2016 Dec;71(6):360-362
Authors: Heng PS, Irfan M
Hypopharyngeal cancer (HPC) is generally a rare head and neck malignancy. There are differing clinical presentations depending on the subsite location of primary tumour. Advanced HPC will have neck node metastasis particularly upper jugulodigastric nodes. We report a patient with postcricoid tumour who presented with anterior huge neck swelling mimic thyroid mass. The patient first presented to the General Surgical Unit for management of presumed thyroid lesion. She was diagnosed post-cricoid squamous cell carcinoma when further assessed by otorhinolaryngologist.
PMID: 28087965 [PubMed - in process]
Arrythmogenic Right Ventricular Dysplasia.
Med J Malaysia. 2016 Dec;71(6):357-359
Authors: Anis Munirah MK, Lim WK, Sharifah Ainon IM
A 10-year-old well and asymptomatic female was referred for screening of acute right ventricular dilatation (ARVD) as she had an elder brother diagnosed with ARVD whom died of sudden cardiac death. Electrocardiography (ECG), transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR) were performed. Results of these investigations were suggestive of ARVD. Despite being a rare cardiac disease and largely unrecognised in children and young adult population, ARVD is an important cause of ventricular arrhythmias in this group of patients and is one of the causes of sudden cardiac death (SCD) in this population.
PMID: 28087964 [PubMed - in process]
Vitamin-D-deficiency rickets even with abundant sunlight -A case to highlight emerging problem.
Med J Malaysia. 2016 Dec;71(6):354-356
Authors: Ting TH, Devnani AS
We describe a case of vitamin-D-deficiency rickets in a young child to highlight its existence in Malaysia where sunlight is abundant throughout the year. The child presented with deformity of both legs. He came from an educated urban family but remained indoors most of the time. Radiographs of knees and wrists showed changes of florid rickets. Low serum 25-hydoxyvitamin-D, high parathyroid hormone, normal serum phosphate and calcium levels, and normal renal function clinched the diagnosis of vitamin-D-deficiency rickets. He improved remarkably after treatment with oral Vitamin-D. We emphasise the importance of exposure to sunlight to prevent rickets.
PMID: 28087963 [PubMed - in process]
Angry patient with fibromyalgia: Diagnosis and management in primary care.
Med J Malaysia. 2016 Dec;71(6):351-353
Authors: Teoh SH
I report a case of 40-year-old lady who presented with symptoms and signs suggestive of fibromyalgia but was disregarded by attending doctor. She was infuriated and lodged a complaint to Family Medicine Specialist (FMS) whereby further assessment confirmed the diagnosis of fibromyalgia and subsequently treated in primary care setting.
PMID: 28087962 [PubMed - in process]
Treatment of Heavily Pre-treated Metastatic Breast Cancer with Eribulin: First local experience in Sabah.
Med J Malaysia. 2016 Dec;71(6):348-350
Authors: Lee DW, Teoh DC, Chong FL
There are many options in the treatment of heavily pretreated metastatic breast cancer however none of the therapeutic agents have shown promising improvement of survival with good toxicity profile. Eribulin is a novel nontaxane microtubule dynamics inhibitor. Two recent clinical trial showed that Eribulin improves progression-free and overall survival in this subset of patients. We report our experience with using Eribulin in five patients with metastatic breast cancer either in second or third-line setting, in our centre.
PMID: 28087961 [PubMed - in process]
Retention of Knowledge following training of students in Basic Trauma Life Support.
Med J Malaysia. 2016 Dec;71(6):346-347
Authors: Lim KG, Lum SK, Burud IA
INTRODUCTION: In the course of their undergraduate training at the International Medical University, students receive a Basic Trauma Life Support course.
OBJECTIVE: We wanted to test the long-term retention of knowledge (after 16 months) of third year medical students who had received training in Basic Trauma Life Support Method: To assess the retention of knowledge one cohort of students who received the training course were tested again 16 months later using the same 30 question One Best Answer quiz.
RESULTS: Seventy-three students who underwent the course sat for the Retention test. The number of students who passed the Retention test was not significantly different from the test taken immediately after the course. The mean scores, 62.5% and 59.5% respectively, were however significantly different.
CONCLUSION: Our study involves a relatively long interval between the course and retention of knowledge test shows encouraging results.
PMID: 28087960 [PubMed - in process]
A study on HLA-DR/DQ typing in adult Malay patients with acute amoebic liver abscess.
Med J Malaysia. 2016 Dec;71(6):341-345
Authors: Nazli Z, Azira NM, Zeehaida M, Nik Zairi Z, Nurul Khaiza Y, Maya Mazuwin Y
INTRODUCTION: Amoebiasis is a parasitic disease caused by Entamoeba histolytica that may lead to death in developing countries. Few important risk factors have been identified in the development of amoebic liver abscess (ALA). There are limited reports that suggest an association between antigens of the major histocompatibility complex (MHC) particularly class II antigens and ALA development. This present work aimed at studying the possible association of HLA antigens with ALA and disease severity. Results of the study may serve as a guide for further immunological studies dealing with E. histolytica.
METHODS: This preliminary study involved two groups of subjects: 20 ALA patients in the experimental group and 40 healthy individuals in the control group. Cases were selected from adult Malay patients confirmed with ALA based on clinical signs and symptoms, radiological findings, microbiological findings and who were admitted to the medical or surgical ward, Hospital USM, Kelantan. Venous blood was obtained from each patient and HLA typing was then conducted using polymerase chain reaction specific primer sequence.
RESULTS: HLA DR12 was most frequently found in the healthy control and ALA groups at 40% and 55% respectively. HLA DQ7 and DQ8 were found to have the highest percentage in the ALA group at 65%. In the control group, HLA DQ8 (57.5%) had the highest percentage.
CONCLUSION: HLA antigens play a role in acquisition of ALA and provide understanding of the disease outcome.
PMID: 28087959 [PubMed - in process]
The teaching of trauma management in undergraduate medical education.
Med J Malaysia. 2016 Dec;71(6):338-340
Authors: Lum SK, Subramaniam T
BACKGROUND: The teaching of trauma in medical schools faces many educational and logistic challenges. Issues on what to teach, how to teach, when to teach, who will teach and whether medical students with insufficient exposure to clinical medicine can benefit from a trauma course are unclear.
MATERIALS AND METHODS: A well-designed one day intensive trauma course concentrating on the primary survey was taught to semester seven and semester eight students by a multi-disciplinary team comprising of surgeons, anaesthetists, emergency physicians and trained medical officers. The course comprised of a pre-test of 30 multiple choice questions followed by three hours of lectures, three hours of skill stations and a post-test. The pre-test and posttest scores were analysed using the paired sample t-test and the independent t-test.
RESULTS: The pre- and post-test scores showed significant improvement for both semester seven and semester eight students. Semester seven students, who only had a sevenweek posting in Surgery had pre-test and post-test scores of only 4% less than semester eight students who had an additional six weeks in Orthopaedics and two weeks in Accident and Emergency postings. The use of a multidisciplinary team reduced the logistic burden of finding sufficient surgeons to teach trauma management.
CONCLUSION: Trauma education can be taught to undergraduates by a multidisciplinary team as early as year three, in semester seven. However, the mean score of semester eight students is only at 66%, suggesting that a refresher course prior to graduation at semester ten will be useful. KEY WORDS.
PMID: 28087958 [PubMed - in process]
Cardiovascular risk assessment between urban and rural population in Malaysia.
Med J Malaysia. 2016 Dec;71(6):331-337
Authors: Noor Hassim I, Norazman MR, Diana M, Khairul Hazdi Y, Rosnah I
INTRODUCTION: Cardiovascular disease (CVD) caused significant burden to Malaysia as it accounted for 36% of total deaths. This study aims to evaluate the burden of cardiovascular risk factors among Malaysian adult and assess the difference between urban and rural population in the selected communities.
METHODS: This study is part of the ongoing Prospective Urban Rural Epidemiology (PURE) database, whereby the baseline data were collected since June 2008. CVD risk was measured using INTERHEART risk score which comprised of eleven risk factors i.e. age and gender, family history of heart attack, smoking status, exposure to second hand smoke, diabetes mellitus, hypertension status, waist-hip ratio, self-reported stress, depression, dietary habits and physical activity status.
RESULTS: Majority of the studied participants had low cardiovascular risk (57%). Participants from rural area were generally older, had lower educational status, higher prevalence of smokers, obesity, hypertension, diabetes, and more likely to be depressed. In comparison, urbanites had lower physical activities and more likely to be stressful. Mean INTERHEART score among rural participants were higher, especially for male, in comparison to urbanite (11.5±5.83 vs. 10.01±5.74, p<0.001).
CONCLUSION: Contradict to common beliefs, participants in rural areas generally have higher cardiovascular risk factors compared to their urban counterparts. The rural population should be targeted for focused preventive interventions, taking account the socioeconomic and cultural context.
PMID: 28087957 [PubMed - in process]
Intralesional Injection of OK-432 in Cystic Hygroma.
Med J Malaysia. 2016 Dec;71(6):328-330
Authors: Hazim M, Moses SS, Tan IP
BACKGROUND: Lymphangiomas are congenital malformations of the lymphatic system with characteristic dilated endothelium-lined spaces. It is vulnerability to infection or chemical irritants cause spontaneous reduction in size and in some cases complete resolution. Intralesional injection of OK-432 or Picibanil (lyophilized incubation mixture of Group A Streptococcus pyogenes of human origin) is slowly gaining recognition as its safety and efficacy standards have shown to avoid complications resulting from surgical interventions. The objective of this study was to evaluate the clinical outcomes of cystic hygroma patients who received OK-432 injections.
METHODS: In between 2011 and 2013, six patients with cystic hygroma received intralesional injection of OK-432. All the patients were assessed clinically and radiologically either via ultrasound, computer tomography (CT) or magnetic resonant imaging (MRI) prior to and after receiving the injections. Patients' response towards treatment was classified as total shrinkage, marked shrinkage (greater than 50% reduction in size), slight shrinkage (less than 50% reduction in size) or non-responsive to treatment.
RESULTS: Mean duration of follow-up was 12 months. Total shrinkage was achieved in one patient, marked shrinkage in three patients and one patient experienced mild shrinkage. Only one out of the six patients showed no response to treatment. None of the patients in this study experienced serious complications or adverse effects post intralesional injection of OK-432.
CONCLUSIONS: Intralesional OK-432 injection is an effective and safe alternative in treating cystic hygroma.
PMID: 28087956 [PubMed - in process]
Water as neutral oral contrast agent in abdominopelvic CT: comparing effectiveness with Gastrografin in the same patient.
Med J Malaysia. 2016 Dec;71(6):322-327
Authors: Lee CH, Gu HZ, Vellayappan BA, Tan CH
INTRODUCTION: Positive oral contrast is no longer deemed necessary for abdominopelvic computed tomography (CT) scans. Studies have shown water to be an equally effective oral contrast agent. However, to our knowledge no study has compared effectiveness between gastrografin and water in the same patient, which will provide a more objective evaluation of the two oral contrast agents. We aim to make a head-to-head comparison of water as neutral oral contrast (OC) against gastrografin as positive OC for abdominopelvic CT scans in the same patient.
METHODS: A retrospective review of 206 abdominopelvic CT scans of 103 patients was performed. The scans were reviewed in consensus by two blinded radiologists. The ability to visualise each abdominopelvic organ, contrastassociated artefacts and small bowel wall delineation, was qualitatively scored on a 5-point scale. Each patient had two sets of scores, one with water and another with gastrografin as OC. Paired scores from the two OCs were evaluated by Wilcoxon signed rank test to determine any significant difference in performance between the two OCs for visualisation of abdominopelvic anatomy on CT.
RESULTS: There was significantly better delineation of duodenal wall (p<0.001) and overall visualisation of the duodenum (p=0.011) using water as OC compared to gastrografin. No statistically significant differences were demonstrated between water and gastrografin for visualisation of the rest of the abdominopelvic organs, walldelineation of the rest small bowel and contrast-associated artefacts.
CONCLUSIONS: Water can be used in place of gastrografin as oral contrast in abdominopelvic CT without compromising visualization of abdominopelvic organs.
PMID: 28087955 [PubMed - in process]
Functional limitation and health-related quality of life, and associated factors among long term stroke survivors in a Malaysian community.
Med J Malaysia. 2016 Dec;71(6):313-321
Authors: Nor Azlin MN, Aziz NA, Saperi BS, Aljunid SM
PURPOSE: this study aimed to evaluate function and quality of life (QoL) and associated factors among long term stroke survivors in the Malaysian community.
METHODS: A cross-sectional study was conducted involving stroke survivors living in the community at two or more years post-stroke. Eligible participants with the diagnosis of stroke were identified from 2005-2010 case mix database of a tertiary hospital. the patients' medical records were analysed and data on demographic and clinical profiles were collected. telephone interviews were conducted to assess existing stroke-related impairments, comorbidities, stroke recurrences, current level of function and QoL, with the usage of rivermead mobility index (rMI), barthel index (bI) and stroke specific quality of life scale (ssQOL).
RESULTS: A total of 203 stroke survivors; mean age 64.5 (standard Deviation(sD) 12.2) years, 45.3% males, stroke duration 44.7 (sD 13.8) months completed the interviews. Mean rMI was 11.7 (sD 3.4) and bI was 89.8 (sD 19.8). Forty three percent and 99% had difficulty in ascending/descending stairs and fast walking, respectively. Up to 20% had limitations in most of the bI subsets. Mean ssQOL was 207.6 (sD 37.2), with domains mostly affected were 'energy' and 'social role'. Function and QOL were both influenced by age (p<0.01) and stroke related impairments (p<0.05), but not by co-morbidities or stroke recurrence. QoL and function (both mobility and ADL) were strongly positively correlated with each other (p<0.01).
CONCLUSIONS: It was observed that functional limitations especially mobility, remains post-stroke major problem and were attributed mainly to stroke-related impairments.
PMID: 28087954 [PubMed - in process]
Tenofovir-induced nephrotoxicity: A retrospective cohort study.
Med J Malaysia. 2016 Dec;71(6):308-312
Authors: Koh HM, Suresh K
BACKGROUND: Tenofovir (TDF) has been associated with renal function deterioration, but local data regarding the incidence and risk factors for this adverse event were lacking.
OBJECTIVES: To determine the incidence of nephrotoxicity in HIV-infected patients on tenofovir-based regimens and to evaluate risk factors involved in tenofovir-associated renal function decline.
METHODS: This is a single-centre retrospective cohort study of 440 HIV-infected adults who were started on tenofovirbased antiretroviral regimens. Data were extracted from electronic medical and pharmacy records.
RESULTS: A decline in eGFR of 25% or more was seen in 67 patients (15.2%) with an estimated incidence rate of 12 per 100 person-years. Among all 440 subjects, 22 discontinued TDF-based therapy due to renal complication. From multivariate analysis, the odds of developing >25% decrease in eGFR with tenofovir-containing regimen was three times higher for patients with baseline moderate renal impairment (HR 3.19; 95% CI, 1.43-7.12; p=0.005) and 14 times higher for patients with baseline severe renal impairment (HR 14.2; 95% CI, 11.20-170.7; p=0.036) as compared to those without pre-existing renal insufficiency. Age above 50 years and CD4 cell count of less than 50 were significantly associated with >25% decrement in eGFR.
CONCLUSION: The incidence rate of tenofovir-related renal dysfunction was found to be 12 per 100 person-years. Preexisting renal impairment, age 50 and above, and CD4 cell count below 50 as were predictors for renal function decline. Given that the use of tenofovir is escalating in Malaysia, increased awareness about this adverse event is essential.
PMID: 28087953 [PubMed - in process]
An observational study of trigeminal neuralgia patients taking carbamazepine during the fasting month of Ramadan.
Med J Malaysia. 2016 Dec;71(6):305-307
Authors: Ajura AJ, Lau SH, Nur Suffia S
INTRODUCTION: Trigeminal neuralgia is an agonising orofacial pain affecting unilaterally the distribution of the trigeminal nerve and it usually occurs in the middle and older age groups. Carbamazepine which is an anti-neuralgic as well as an anti-convulsant medication is the first line drug for treatment of trigeminal neuralgia. It is commonly taken as one tablet (200 mg) three times a day.
MATERIALS AND METHODS: This is an observational study carried out from April to September 2014 to determine how Muslim patients on carbamazepine treatment for trigeminal neuralgia cope with their neuralgic pain. The pattern of how the medication was taken during the fasting month of Ramadan was also observed.
RESULTS: A total of 29 patients participated in this study and 27(93%) observed the fast. Ten of them adjusted the carbamazepine dose from three times pre-Ramadan to twice daily during the fasting month. Three patients continued fasting despite feeling the pain during the daytime while five patients had their pain under control with the newly adjusted dose.
CONCLUSION: Medical professionals should advise trigeminal neuralgia patients on how to take and adjust their carbamazepine dose during the fasting month.
PMID: 28087952 [PubMed - in process]