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Preview: pubmed: Med J Malaysia[Jour]

pubmed: Med J Malaysia[Jour]



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Septic miscarriage with toxic shock syndrome and disseminated intravascular coagulation (DIC): The role of surgery, recombinant activated factor VII and intravenous immunoglobulin (IVIG).

Septic miscarriage with toxic shock syndrome and disseminated intravascular coagulation (DIC): The role of surgery, recombinant activated factor VII and intravenous immunoglobulin (IVIG).

Med J Malaysia. 2017 Dec;72(6):380-381

Authors: Tan LN, Mariappa G, Voon HY, Suharjono H

Abstract
Severe sepsis with multi-organ failure is associated with a high mortality rate. This case report highlights the challenges and modalities available in the management of a lady with refractory shock and disseminated intravascular coagulation (DIC) due to toxic shock syndrome (TSS) from genital tract sepsis. Early surgical intervention to remove the source of infection, the use of recombinant activated factor VII to treat intractable disseminated intravascular coagulation and intravenous immunoglobulin to neutralise the circulating exotoxins, have been employed and shown to drastically improve outcomes.

PMID: 29308782 [PubMed - in process]




Community-acquired necrotising pneumonia caused by Panton-Valentine leucocidin-producing methicillin-resistant Staphylococcus aureus.

Community-acquired necrotising pneumonia caused by Panton-Valentine leucocidin-producing methicillin-resistant Staphylococcus aureus.

Med J Malaysia. 2017 Dec;72(6):378-379

Authors: Leong CL, Norazah A, Azureen A, Lingam R

Abstract
A 61-year-old male presented with community-onset pneumonia not responding to treatment despite given appropriate antibiotics. Computed tomography scan of the thorax showed large multiloculated pleural effusion with multiple cavitating foci within collapsed segments; lesions which were suggestive of necrotising pneumonia. Drainage of the effusion and culture revealed methicillin-resistant Staphylococcus aureus, which had the same antibiotic profile with the blood isolate and PVL gene positive.

PMID: 29308781 [PubMed - in process]




Multiple myeloma masquerading as panuveitis in a middle-aged woman.

Multiple myeloma masquerading as panuveitis in a middle-aged woman.

Med J Malaysia. 2017 Dec;72(6):376-377

Authors: Yew YC, Nurul-Fatin FS, Norazita AT

Abstract
Panuveitis secondary to masquerade syndrome is uncommon. A middle-aged woman presented to the ophthalmology clinic with panuveitis associated with anaemia, joint pain, and renal impairment. An incidental finding of a lytic lesion over her left scapula following a chest x-ray prompted further skeletal survey and revealed further lytic lesions over the skull and pelvic bone. Bone marrow aspiration was performed and this confirmed the diagnosis of multiple myeloma. Her left eye vision and intraocular inflammation improved after commencement of chemotherapy. A detailed history is important to elucidate the aetiology of masquerade syndrome and to prevent any delayed diagnosis of underlying malignancy.

PMID: 29308780 [PubMed - in process]




A frequently missed entity in systemic lupus erythematosus (SLE): Intestinal pseudo-obstruction (IpsO).

A frequently missed entity in systemic lupus erythematosus (SLE): Intestinal pseudo-obstruction (IpsO).

Med J Malaysia. 2017 Dec;72(6):374-375

Authors: Shirley L, Thundyil RJ

Abstract
Intestinal pseudo-obstruction (IpsO) is defined as presence of clinical features of intestinal obstruction without identifiable mechanical obstructive lesion. IpsO is an uncommon gastrointestinal manifestation of systemic lupus erythematosus (SLE) and is largely under-recognised. There are only over 30 published cases in English literature on SLE-related IpsO. Herein, we report two cases of SLE-related IpsO to illustrate the importance of early recognition to avoid unnecessary surgical intervention, as SLE-related IpsO responds well to systemic high dose corticosteroids. These two cases also demonstrate the apparent association of IpsO with uretero-hydronephrosis, suggesting that the possible mechanism could be smooth muscle dysmotility.

PMID: 29308779 [PubMed - in process]




Adult human metapneumovirus encephalitis: A case report highlighting challenges in clinical management and functional outcome.

Adult human metapneumovirus encephalitis: A case report highlighting challenges in clinical management and functional outcome.

Med J Malaysia. 2017 Dec;72(6):372-373

Authors: Tan YL, Wee TC

Abstract
We report a rare case of adult human metapneumovirus (HMPV) in a healthy 32-year-old man. There was dramatic deterioration in his condition developing pneumonia with Type-I respiratory failure and encephalitis. He needed mechanical ventilation in the intensive care setting and was treated with intravenous ribavirin. Post-extubation he remained severely physically and cognitively impaired despite rehabilitation. Treatment of HMPV pneumonia is at present, still without specific antiviral therapy. Managing HMPV-encephalitis remained supportive and challenging. More definite treatment strategies are needed.

PMID: 29308778 [PubMed - in process]




Rare complication of appendix: small bowel gangrene caused by the appendicular knot.

Rare complication of appendix: small bowel gangrene caused by the appendicular knot.

Med J Malaysia. 2017 Dec;72(6):370-371

Authors: Mohana RT, Zainal AA

Abstract
Intestinal knot formation was first described by Riverius in 16th century and later by Rokitansky in 1836. We report a very rare cause of small bowel gangrene caused by appendiceal knotting on to the ileum in a previously healthy mid aged lady. Patient underwent laparatomy and right hemicolectomy and primary anastomosis. The intra operative findings were the appendix was twisting (knotting) the small bowel about 40cm from the terminal ileum and causing gangrene to the segment of small bowel. Appendicitis is a common condition and management is usually straightforward. However we must be aware of rare complications which may arise that require a change from the standard treatment of acute appendicitis.

PMID: 29308777 [PubMed - in process]




Necrotising pneumonia: A pneumonia that may need surgical intervention.

Necrotising pneumonia: A pneumonia that may need surgical intervention.

Med J Malaysia. 2017 Dec;72(6):367-369

Authors: Ooi SY, Lee SW

Abstract
Pneumonia is primarily a disease that is usually managed medically with antibiotics. However, in rare cases it may progress to necrotising pneumonia, which is an uncommon but severe complication of bacterial pneumonia. This case illustrates a typical case of necrotising pneumonia complicated with parenchymal and pleural complication such as empyema, pneumothorax with possible bronchopleural fistula. Early consultation with thoracic surgeon can be life-saving.

PMID: 29308776 [PubMed - in process]




A case of immune thrombocytopenic purpura with prolonged aPTT time: A clotter hidden in a bleeder?

A case of immune thrombocytopenic purpura with prolonged aPTT time: A clotter hidden in a bleeder?

Med J Malaysia. 2017 Dec;72(6):365-366

Authors: Lee MH, Khoo PJ, Gew LT, Ng CF

Abstract
We report the case of a 23-year-old woman who presented with prolonged menstruation and multiple bruises on the limbs and trunk. Investigations revealed severe thrombocytopenia and deranged coagulation profile with markedly prolonged activated partial thromboplastin time (aPTT). Lupus anticoagulant, anti-cardiolipin antibody and anti-beta-2-glycoprotein 1 antibody were positive. She was diagnosed with Immune Thrombocytopenic Purpura (ITP) with positive antiphospholipid antibody serology and given a course of intravenous methylprednisolone and tapering doses of oral prednisolone. She was steroid free and had no bleeding or thrombotic event over two years follow up.

PMID: 29308775 [PubMed - in process]




A comparison of dabigatran and warfarin for stroke prevention in elderly Asian population with nonvalvular atrial fibrillation: An audit of current practice in Malaysia.

A comparison of dabigatran and warfarin for stroke prevention in elderly Asian population with nonvalvular atrial fibrillation: An audit of current practice in Malaysia.

Med J Malaysia. 2017 Dec;72(6):360-364

Authors: Yap SH, Ng YP, Roslan A, Kolanthaivelu J, Koh KW, P'ng HS, Boo YL, Hoo FK, Yap LB

Abstract
INTRODUCTION: Atrial fibrillation (AF) is the most common cardiac arrhythmia with significant morbidity and mortality in relation to thromboembolic stroke. Our study aimed to evaluate the safety and efficacy of dabigatran in stroke prevention in elderly patient with nonvalvular AF with regard to the risk of ischemic stroke and intracranial haemorrhage (ICH) in real-world setting.
METHODS: A retrospective cohort study of 200 patients on dabigatran and warfarin from January 2009 till September 2016 was carried out. Data were collected for 100 patients on dabigatran and 100 patients on warfarin.
RESULTS: The mean follow-up period was 340.7±322.3 days for dabigatran group and 410.5±321.2 days for warfarin group. The mean time in therapeutic range (TTR) was 52±18.7%. The mean CHA2DS2 -VASc score for dabigatran group was 4.4±1.1 while 5.0±1.5 for warfarin group. None in dabigatran group experienced ischemic stroke compared to one patient in warfarin group (p=0.316). There was one patient in dabigatran group suffered from ICH compared to none in warfarin group (p=0.316). Four patients in warfarin group experienced minor bleeding, while none from dabigatran group (p=0.043).
CONCLUSION: Overall bleeding events were significantly lower in dabigatran group compared to warfarin group. In the presence of suboptimal TTR rates and inconveniences with warfarin therapy, non-vitamin-K antagonist oral anticoagulants (NOAC) are the preferred agents for stroke prevention in elderly Asian patients for nonvalvular AF.

PMID: 29308774 [PubMed - in process]




Evaluation of visual outcomes after toric intraocular lens implantation.

Evaluation of visual outcomes after toric intraocular lens implantation.

Med J Malaysia. 2017 Dec;72(6):356-359

Authors: Ng HR, Goh CH, Ngim YS, Juliana J

Abstract
PURPOSE: To evaluate postoperative visual acuity, refractive status and rotational stability of toric intraocular lens (IOL) in correcting pre-existing corneal astigmatism.
METHODS: A total of 69 patients with topographic corneal astigmatism of 1.0 Diopter (D) and above who underwent cataract surgery between June 2015 and December 2016 were included in this retrospective observational study. All preoperative toric IOL calculations were performed using immersion biometry. Appropriate formula to calculate toric IOL power was applied (SRK/T, Holladay 1 or Hoffer Q formula). All patients undergone similar uncomplicated phacoemulsification with implantation of AcrySoft IQ SN6AT toric IOL of different powers. Visual outcome, refractive status and axis of lens were evaluated at six weeks postoperatively. Ethical approval from the Ministry of Health Medical Research Ethics Committee was obtained prior to commencement of study.
RESULTS: The mean refractive astigmatism decreased from 1.69 D ±1.10 (SD) to 0.81 D ± 0.40 (SD) at six weeks postoperatively. The mean postoperative spherical equivalent was at -0.37 D ±0.64 (SD). Mean LogMAR for uncorrected and corrected distance visual acuity in six weeks postoperative patients was at 0.29 ±0.16 (SD) and 0.12 ±0.12 (SD) respectively. Intraoperative to 6 weeks of postoperative comparison of IOL axis alignment showed low levels of rotation (mean 3.21 ±2.52 degrees).
CONCLUSION: Cataract surgery with implantation of toric IOL was stable and effective in improving pre-existing regular corneal astigmatism.

PMID: 29308773 [PubMed - in process]




Psychometric properties of the Malay-translated General Practice Physical Activity Questionnaire among shipyard workers.

Psychometric properties of the Malay-translated General Practice Physical Activity Questionnaire among shipyard workers.

Med J Malaysia. 2017 Dec;72(6):350-355

Authors: Arma N, Rosnah I, Noor Hassim I

Abstract
BACKGROUND: The General Practice Physical Activity Questionnaire (GPPAQ) is a validated and reliable screening tool to measure the level of physical activity in adults. However, it has never been translated and validated in Malaysian population. This study aimed to translate the GPPAQ into Malay language and to evaluate the psychometric properties of the Malay-translated GPPAQ among shipyard workers.
METHODS: The original English version of GPPAQ was translated forward and backward into Malay version by experts. The final version of the Malay-translated GPPAQ was then tested for validity and reliability. A cross-sectional study design was performed and systematic random sampling was used to select respondents. Construct validity and internal consistency of the Malay-translated version were tested using exploratory factor analysis and Cronbach's alpha respectively.
RESULTS: Sixty-two male shipyard workers participated in this study. The GPPAQ showed good factor loading values for all items (0.608-0.834). The exploratory principal component factor analysis delineates all seven items into two factors with variance of 41.65%. The Cronbach's alpha value was good with 0.81, 0.84 and 0.76 for total scale, factor 1 and factor 2 respectively.
CONCLUSION: The Malay-translated version of GPPAQ has high psychometric properties. Therefore, it is a valid instrument to assess physical activity among Malaysian working population, particularly in male shipyard workers.

PMID: 29308772 [PubMed - in process]




Clinical features and prognostic factors of cutaneous vasculitis among dermatology patients in Johor Bahru, Malaysia.

Clinical features and prognostic factors of cutaneous vasculitis among dermatology patients in Johor Bahru, Malaysia.

Med J Malaysia. 2017 Dec;72(6):345-349

Authors: Latha S, Choon SE, Tey KE, Chee YN

Abstract
BACKGROUND: Cutaneous vasculitis is common, yet the risk factors for its chronicity have not been established.
OBJECTIVE: To describe the clinical spectrum and identify risk factors for chronicity of cutaneous vasculitis.
METHODS: Retrospective data analysis of 275 patients diagnosed with cutaneous vasculitis from January 2008 to December 2013.
RESULTS: The mean age was 33.7 (±17.89) years, with female predominance. The majority of patients were Malays (67.3%). Skin biopsy was performed in 110 (40%) patients. The commonest sign was palpable purpura (30.6%). The aetiology remained elusive in 51.3% of patients. Common identifiable causes include infection (19.7%) and connective tissue disease (10.2%). Extracutaneous features were noted in 46.5% of patients. Erythrocyte sedimentation rate and antinuclear antibody were raised in 124 of 170 and 27 of 175 patients with documented results respectively. Cutaneous vasculitis was the presenting symptom in seven patients with newly diagnosed systemic lupus erythematosus. Anti Streptolysin O Titre was positive in 82 of 156 patients with documented results. Despite antibiotics, 31.7% of them had chronic lesions. Prednisolone alone was used in 20% of patients while 16.4% needed steroid-sparing agents. Most patients who needed systemic therapy (62%) had unidentifiable aetiology. Among the 155 patients who remained under follow up, 36.4% had chronic disease, one patient succumbed due to septicaemia, and the rest fully recovered within three months. The presence of ulcerative lesion was significantly associated with developing chronic vasculitis (p=0.003).
CONCLUSION: The clinical spectrum of cutaneous vasculitis in our population was similar to other studies. Ulcerative lesion predicts a chronic outcome.

PMID: 29308771 [PubMed - in process]




Assessment of the level of knowledge of colorectal cancer among public at outpatient clinics in Serdang Hospital: a survey based study.

Assessment of the level of knowledge of colorectal cancer among public at outpatient clinics in Serdang Hospital: a survey based study.

Med J Malaysia. 2017 Dec;72(6):338-344

Authors: Pan Y, Chieng CY, Haris AAH, Ang SY

Abstract
OBJECTIVES: Colorectal cancer (CRC) is one of the most common gastrointestinal cancers in the world. In the Asia- Pacific region, it is the fastest emerging gastrointestinal cancer. Level of awareness on CRC warning signs and risk factors in the rural population of Malaysia is reported of very low. The aim of this study was to assess the level of knowledge of CRC among the public at medical outpatient clinics in Serdang Hospital. The association between sociodemographic factors with level of knowledge among the respondents was further studied.
STUDY DESIGN: A study was conducted among the non-CRC patients' relatives accompanying their relatives to the medical outpatient clinics in Serdang Hospital from 1st April to 31st August 2016. The study was carried out with cluster sampling method.
METHODS: The respondents were assessed using validated and modified Cancer Awareness Measures (CAM) questionnaire consists of three parts which are knowledge on warning signs, knowledge on risk factors and sociodemographic factors. All data were analysed using IBM SPSS Statistics 21.0.
RESULTS: Altogether 308 subjects completed the questionnaires. It was shown high percentage of good knowledge for warning signs and risk factors of CRC among the respondents. A significant association between age groups and level of income with level of knowledge on warning signs was observed.
CONCLUSIONS: The level of knowledge of CRC among the general public in Serdang Hospital was sufficient. The respondents with higher income or younger age had higher level of knowledge regarding CRC.

PMID: 29308770 [PubMed - in process]




Health-seeking behaviour among patients with faecal incontinence in a Malaysian academic setting.

Health-seeking behaviour among patients with faecal incontinence in a Malaysian academic setting.

Med J Malaysia. 2017 Dec;72(6):333-337

Authors: Roslani AC, Ramakrishnan R, Azmi S

Abstract
BACKGROUND: Faecal incontinence (FI) is not a common presenting complaint in Malaysia, and little has been published on this topic. Since it is a treatable condition, a greater understanding of factors contributing to healthseeking behaviour is needed in order to plan effective provision of services.
METHODS: A survey of 1000 patients and accompanying relatives, visiting general surgical and obstetrics and gynaecology clinics for matters unrelated to FI, was conducted at University Malaya Medical Centre between January 2009 and February 2010. A follow-up regression analysis of the 83 patients who had FI, to identify factors associated with health-seeking behaviour, was performed. Variables identified through univariate analysis were subjected to multivariate analysis to determine independence. Reasons for not seeking treatment were also analysed.
RESULTS: Only eight patients (9.6%) had sought medical treatment. On univariate analysis, the likelihood of seeking treatment was significantly higher among patients who had more severe symptoms (OR 30.0, p=0.002), had incontinence to liquid stool (OR 3.83, p=0.002) or when there was an alteration to lifestyle (OR: 17.34; p<0.001). Nevertheless, the only independently-associated variable was alteration in lifestyle. Common reasons given for not seeking treatment was that the condition did not affect patients' daily activities (88.0%), "social taboo" (5.3%) and "other" reasons (6.7%).
CONCLUSIONS: Lifestyle alteration is the main driver of healthseeking behaviour in FI. However, the majority do not seek treatment. Greater public and physician-awareness on FI and available treatment options is needed.

PMID: 29308769 [PubMed - in process]




Factors influencing outcome after hepatic portoenterostomy among extrahepatic bile duct atresia patients in Hospital Sultanah Bahiyah, Alor Setar.

Factors influencing outcome after hepatic portoenterostomy among extrahepatic bile duct atresia patients in Hospital Sultanah Bahiyah, Alor Setar.

Med J Malaysia. 2017 Dec;72(6):329-332

Authors: Namasemayam D, Nallusamy M

Abstract
INTRODUCTION: Biliary atresia implies high risk of mortality if not diagnosed and treated early. We undertook this study to assess the prognostic factors affecting the outcome of Kasai surgery.
METHODS: A retrospective clinical study was conducted among 58 patients from Hospital Sultanah Bahiyah Alor Setar. Data were analysed with logistic regression analysis using SPSS. Factors studied included age during surgery, bile duct diameter at the porta hepatic, race of patient, preoperative total bilirubin level and cholangitis. These factors were analysed to determine its significance as a prognostic factor affecting the outcome of Kasai surgery.
RESULTS: Older age group above 56 days of life, bile duct diameter at porta hepatis measuring <50μm, pre-operative total bilirubin >10mg% and cholangitis were found to be poor prognostic factors from univariate regression analysis. Variables having p value<0.025 were analysed using the multivariable regression analysis. Only age of patient and diameter of bile duct at the porta hepatis were eligible for this analysis. The final analysis showed that age 57 days of life and above (adjusted odd's ratio (aOR) = 9.412, p value = 0.042, 95% confidence interval (95%CI) = 1.079 to 82.104) and bile duct diameter <50μm (aOR = 13.812, p value = 0.016, 95%CI = 1.616 to 118.042) were significant factors affecting the outcome.
CONCLUSION: In conclusion, age of patient 56 days of life and younger and diameter of bile duct at porta hepatis ≥50μm gave a significantly better outcome after Kasai surgery.

PMID: 29308768 [PubMed - in process]