MyMedR

Fulltext Appendicular mass complicating acute appendicitis in a patient with dengue fever

Low YN, Cheong BM

Med J Malaysia, 2016 04;71(2):83-4.

Abdominal pain with dengue fever can be a diagnostic challenge. Typically, pain is localised to the epigastric region or associated with hepatomegaly. Patients can also present with acute abdomen. We report a case of a girl with dengue fever and right iliac fossa pain. The diagnosis of acute appendicitis was made only after four days of admission. An appendicular mass and a perforated appendix was noted during appendectomy. The patient recovered subsequently. Features suggestive of acute appendicitis are persistent right iliac fossa pain, localised peritonism, persistent fever and leucocytosis. Repeated clinical assessment is important to avoid missing a concurrent diagnosis like acute appendicitis.

Capgras syndrome in a very late onset, treatment resistant schizophrenia

Ain MK, Rosdinom R, Raynuha M

Int Psychogeriatr, 2015 Sep;27(9):1573-5.

PMID: 25794136 DOI: 10.1017/S1041610215000332

We report a Malay man, with underlying chronic medical illnesses, presenting with positive symptoms of schizophrenia, including Capgras syndrome (CS) at the age of 73. Physical examination and blood investigations were normal and brain CT scan showed age-related cerebral atrophy. Neuropsychological assessment showed probable right hemisphere lesions but relatively intact memory and intellectual functions. Several neuroleptics including depot injections were tried but ineffective. Positive symptoms including CS eventually improved with clozapine before his death from myocardial infarction. This case report highlights the uncommon occurrence of CS in treatment resistant schizophrenia (TRS) of very late onset and its treatment challenges.

Fulltext Revascularization for foot salvage in diabetic critical foot ischaemia

Yii MK, Liew NC

Med J Malaysia, 1999 Sep;54(3):325-8.

PMID: 11045058

A consecutive series of 32 diabetic patients, 16 male and 16 female, who presented to the authors with critical limb ischaemia was reviewed over a two-year period. Atherosclerotic risk factors and co-morbidities were present in 56% of these patients. Diagnostic angiography was performed in all patients. Revascularization was achieved in 91% of the cases with three perioperative deaths. Ten bypasses were anastomosed distally to one of the crural or ankle arteries at the foot. Major amputations were required in five patients who had had revascularization and in 4 of these gross sepsis was the main factor responsible for limb loss despite patent grafts. The primary graft patency rates at one month and one year were 96% and 90% respectively. Surgical reconstruction was possible in the majority of diabetic patients with critical ischaemia and should be offered to patients preferably before the establishment of gross sepsis to improve limb salvage.

Fulltext Detection of gene deletions by PCR analysis in a Malaysian patient with Duchenne muscular dystrophy

Lee MK, Manonmani V, Arahata K

Med J Malaysia, 1993 Mar;48(1):46-50.

PMID: 8341171

Duchenne muscular dystrophy (DMD), the commonest X-linked disorder, is a progressive, eventually fatal disease. With the advent of molecular genetics, the Duchenne gene and its protein product, dystrophin, have been characterised. Molecular diagnosis of DMD, identification of carriers and antenatal diagnosis are now possible. We describe here the use, in a Malaysian boy with DMD, of a recent innovation, multiplex polymerase chain reaction (PCR), to obtain molecular diagnosis by detection of dystrophin gene deletions.

Perforated appendicitis--the Malaysian experience

Lee CM, Teoh MK

J R Coll Surg Edinb, 1990 Apr;35(2):83-7.

PMID: 2355382

Perforated appendicitis, with its increased complication rate, today still poses a formidable problem in the Kuala Lumpur General Hospital. Out of 1694 emergency operations performed by our unit in 1987, there were 927 appendicectomies. A retrospective study of these cases showed 126 cases of perforated appendicitis, which were then subjected to detailed analysis. We have a diagnostic accuracy of 81% and perforation rate of 18%. In addition, it is interesting to note the racial differences in the relationship of diagnostic accuracy to perforation rate. Perforation is associated with an increased wound infection rate. Transperitoneal drainage in perforated appendicitis did not lead to a lower incidence of wound infection or improve postoperative performance. Distinguishing between perforated and non-perforated appendicitis may be difficult. Perforation could occur while awaiting operation. We recommend the early administration of systemic antibiotics should appendicectomy be delayed and the cautious use of drains in cases of perforated appendicitis.

Lumbosacral plexus avulsion with pelvic fractures

Sidhu JS, Dhillon MK

Injury, 1991 Mar;22(2):156-8.

PMID: 2037340

Fulltext Lethal neonatal dwarfism: a case of achondrogenesis

Afzal MK, Choo KE

Med J Malaysia, 1980 Sep;35(1):64-7.

PMID: 7254002

Achondrogenesis is a lethal neonatal chondrodysplasia with extreme micromelia and marked discrepancy between the relatively large head and the decreased trunk length. The affected neonates are usually delivered prematurely, and are stillborn or die soon after birth. Polyhydramnios is frequently present. It is an inherited autosomal recessive disease. The radiographic features are diagnostic.

Cerebral venous thrombosis associated with antithrombin III deficiency

Lee MK, Ng SC

Aust N Z J Med, 1991 Oct;21(5):772-3.

PMID: 1759929

Mercury, lead, and other heavy metals in Chinese medicines

Wong MK, Koh LL

Biol Trace Elem Res, 1986 Aug;10(2):91-7.

PMID: 24254355 DOI: 10.1007/BF02795561

Ninety-nine samples of common Chinese medicines were purchased from Chinese medical shops in Singapore and Malaysia and analyzed for mercury, lead, copper, cadmium, cobalt, iron, and nickel. The majority of these medicines were manufactured in China, Hong Kong, and Malaysia. A few of them were of Singapore and Taiwan origin. Atomic absorption method (both flame and flameless) was used for the analyses. Mercury was found to be present in high concentrations in several of the medicines that were for oral consumption.

Fulltext POSSUM--a model for surgical outcome audit in quality care

Ng KJ, Yii MK

Med J Malaysia, 2003 Oct;58(4):516-21.

PMID: 15190626

Comparative surgical audit to monitor quality of care should be performed with a risk-adjusted scoring system rather than using crude morbidity and mortality rates. A validated and widely applied risk adjusted scoring system, P-POSSUM (Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality) methodology, was applied to a prospective series of predominantly general surgical patients at the Sarawak General Hospital, Kuching over a six months period. The patients were grouped into four risk groups. The observed mortality rates were not significantly different from predicted rates, showing that the quality of surgical care was at par with typical western series. The simplicity and advantages of this scoring system over other auditing tools are discussed. The P-POSSUM methodology could form the basis of local comparative surgical audit for assessment and maintenance of quality care.

Fulltext Risk-adjusted surgical audit with the POSSUM scoring system in a developing country. Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity

Yii MK, Ng KJ

Br J Surg, 2002 Jan;89(1):110-3.

PMID: 11851674

BACKGROUND: The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) is an objective and appropriate scoring system for risk-adjusted comparative general surgical audit. This score was devised in the UK and has been used widely, but application of POSSUM to centres outside the UK has been limited, especially in developing countries. This prospective study validated its application in a surgical practice with a different population and level of resources.
METHODS: All general surgical patients who were operated on under regional or general anaesthesia as inpatients over a 4-month period at Sarawak General Hospital in 1999 were entered into the study. All data (12 physiological and six operative factors) were analysed for mortality only with the POSSUM equation and the modified Portsmouth POSSUM (P-POSSUM) equation. Comparisons were made between predicted and observed mortality rates according to four groups of risk: 0-4, 5-14, 15-49 and 50 per cent or more using the 'linear' method of analysis.
RESULTS: There were 605 patients who satisfied the criteria for the study. Some 56.7 per cent of patients were in the lowest risk group. The POSSUM predictor equation significantly overestimated the mortality in this group, by a factor of 9.3. The overall observed mortality rate was 6.1 per cent and, again, the POSSUM predictor equation overestimated it at 10.5 per cent (P < 0.01). In contrast, the observed and predicted mortality rates for all risk groups, including the predicted overall mortality rate of 4.8 per cent, were comparable when the P-POSSUM predictor equation was used.
CONCLUSION: The POSSUM scoring system with the modified P-POSSUM predictor equation for mortality was applicable in Malaysia, a developing country, for risk-adjusted surgical audit. This scoring system may serve as a useful comparative audit tool for surgical practice in many geographical locations.

Dengue Encephalitis associated with symptomatic hyponatremia due to Syndrome of Inappropriate Antidiuretic Hormone Secretion

Ng WW, Cheong BMK

Med J Malaysia, 2021 03;76(2):261-263.

PMID: 33742642

A previously well 21-year-old girl presented to Hospital Teluk Intan, Perak, Malaysia with a short history of fever, vomiting and altered sensorium. She was diagnosed with dengue encephalitis as her dengue NS-1 antigen was positive and her cerebrospinal fluid (CSF) dengue polymerase chain reaction (PCR) was positive with serotype DENV-2. She also had severe hyponatremia due to Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) which caused an episode of seizure. She recovered well with supportive management. SIADH and dengue encephalitis should be considered as one of the differential diagnosis in patients presenting with fever and altered sensorium especially in dengue endemic countries like Malaysia.

A descriptive analysis of clinical characteristics of COVID-19 among healthcare workers in a district specialist hospital

Tan-Loh J, Cheong BMK

Med J Malaysia, 2021 01;76(1):24-28.

PMID: 33510104

INTRODUCTION: COVID-19 is a highly transmissible respiratory virus that has affected millions of people worldwide in the span of months. The burden of disease among healthcare workers (HCW) has not been well studied despite reports of infectivity and transmission around the world. Two HCW in Hospital Teluk Intan (HTI) contracted COVID-19 while attending a social event. They were in close proximity with colleagues upon returning to work, resulting in the spread of infection among other HCW in HTI.

OBJECTIVE: The objectives of this paper are to gain a better understanding of the key presenting symptoms of COVID-19 in HCWs in a district specialist hospital, to establish the proportion of symptomatic COVID-19 cases among HCWs and its severity and to determine the time taken from onset of symptoms or perceived exposure to diagnostic testing.

METHODOLOGY: This is a retrospective descriptive analysis of clinical characteristics of subjects infected with COVID-19 among HCW in HTI. Their demography and clinical characteristics were recorded.

RESULTS: There were 47 HCW in HTI who tested positive for COVID-19. The mean age of the patients was 37.5 years old. 7 patients (15.2%) had at least more than one comorbidity. Average duration of time from perceived close contact to onset of symptom was 4.5 days, while the mean duration of time from symptoms to first positive RT-PCR result was 3.4 days. Six patients (13.0%) were asymptomatic throughout, whereas 40 (87.0%) had at least one symptom prior to hospitalization. The most commonly reported symptoms were fever (65.2%), sore throat (39.1%) and cough (37.0%). In terms of severity of symptoms, the majority of patients experienced mild symptoms (Group 2, 52.2%). Two patients (4.3%) with multiple comorbidities had severe disease requiring ICU admission and mechanical ventilation. There were no mortalities, and the longest staying patient was hospitalized for 18 days. The high rates of infectivity among HCW in HTI can be attributed to working in close proximity while in the asymptomatic incubation phase, while no HCW directly involved in the care of COVID-19 positive patients were tested positive.

CONCLUSION: We report that HCW share similar clinical characteristics of COVID-19 infection as those of non HCW patients in earlier studies. The infection can spread rapidly within healthcare settings via close contacts among infected HCWs. As such, we advocate distancing when working and usage of personal protective equipment when treating patients with respiratory illness to reduce transmission of COVID-19.

Fulltext Congenital cholesteatoma: Different clinical presentation in two cases

Abdul Jalil S, Md Daud MK

Malays Fam Physician, 2016;11(2-3):30-32.

PMID: 28461856

INTRODUCTION: Congenital cholesteatoma (CC) of the middle ear is a rare entity that may be undiagnosed for years. The lesion can grow undetected until it produces symptoms such as reduced hearing or otalgia.

METHOD: Case report.

RESULTS: We report two cases of young ladies with CC who presented with different otological symptoms. The first case complained of recurrent unilateral ear pain while the second case presented with unilateral reduced hearing. Examination of both cases revealed a whitish mass seen behind an intact tympanic membrane. Both cases underwent surgery and histopathological examinations; findings were consistent with cholesteatoma.

CONCLUSION: There are varieties of clinical presentations of CC and the diagnosis is based on clinical findings.

Fulltext Approximation solution for system of generalized ordered variational inclusions with ⊕ operator in ordered Banach space

Sarfaraz M, Ahmad MK, Kılıçman A

J Inequal Appl, 2017;2017(1):81.

PMID: 28479833 DOI: 10.1186/s13660-017-1351-x

The resolvent operator approach is applied to address a system of generalized ordered variational inclusions with ⊕ operator in real ordered Banach space. With the help of the resolvent operator technique, Li et al. (J. Inequal. Appl. 2013:514, 2013; Fixed Point Theory Appl. 2014:122, 2014; Fixed Point Theory Appl. 2014:146, 2014; Appl. Math. Lett. 25:1384-1388, 2012; Fixed Point Theory Appl. 2013:241, 2013; Eur. J. Oper. Res. 16(1):1-8, 2011; Fixed Point Theory Appl. 2014:79, 2014; Nonlinear Anal. Forum 13(2):205-214, 2008; Nonlinear Anal. Forum 14: 89-97, 2009) derived an iterative algorithm for approximating a solution of the considered system. Here, we prove an existence result for the solution of the system of generalized ordered variational inclusions and deal with a convergence scheme for the algorithms under some appropriate conditions. Some special cases are also discussed.

Pneumatosis intestinalis: a case report with a brief review of literature

Kutty MK, Nambiar B, Bau K

Med J Malaya, 1970 Mar;24(3):227-30.

PMID: 4246807

Testicular adenocarcinoma of infancy

Dutt AK, Kutty MK

Med J Malaya, 1969 Jun;23(4):298-9.

PMID: 4242177

A case of human Sarcocystis infection in west Malaysia

Kutty MK, Dissanaike AS

Trans R Soc Trop Med Hyg, 1975;69(5-6):503-4.

PMID: 820020

The first case of Sarcocystis infection is reported from West Malaysia. A cyst was seen as an incidental finding in a biopsy specimen from the larynx of the patient. The cyst and the cystozoites were of the small size with no evidence of cytophaneres or compartments.

A case of pulmonary hydatid disease

Kutty MK, Krishnan M, Nambiar B

Med J Malaya, 1970 Jun;24(4):302-5.

PMID: 4248353

Eurycoma longifolia JACK and orientation activities in sexually experienced male rats

Ang HH, Sim MK

Biol Pharm Bull, 1998 Feb;21(2):153-5.

PMID: 9514610 DOI: 10.1248/bpb.21.153

The effects of Eurycoma longifolia JACK were studied on the orientation activities of sexually experienced male rats towards receptive females (mounting, licking, anogenital sniffing), environment (exploration, raring, climbing), themselves (genital grooming, non-genital grooming) and mobility (unrestricted, restricted) after dosing them with 200, 400 and 800 mg/kg body weight twice daily for 10 d prior to the test. The results showed that E. longifolia JACK modified the orientation activities of the treated male rats in that they significantly displayed more frequent and vigorous mounting, licking and anogenital sniffing towards the receptive females, and it further intensified self orientation as indicated by the increased grooming of the genitals compared to the controls (p<0.05). In addition, rats treated with 800 mg/kg of methanol, water and butanol extracts of E. longifolia JACK continued to show confinement to a particular area of the cage (around the female), thus showing restriction in movement as compared to the controls (p<0.05). However, the treated males possessed a lack of interest in the external environment as indicated by a reduction in exploration, raring and climbing on the cage wall. Hence, the present study further supports the folk use of E. longifolia JACK as an aphrodisiac.

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